Provider Demographics
NPI:1740250695
Name:HARLA, S ROBERT (DO)
Entity type:Individual
Prefix:
First Name:S
Middle Name:ROBERT
Last Name:HARLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:ROBERT
Other - Last Name:HARLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3500 JEFFERSON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6200
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:512-323-5880
Practice Address - Street 1:160 CREEKSIDE PARK RD
Practice Address - Street 2:STE 300
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6150
Practice Address - Country:US
Practice Address - Phone:512-451-0139
Practice Address - Fax:512-323-5880
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133607508Medicaid
TX8FC810OtherBCBS PV#
TXP00998010OtherRAILROAD MEDICARE
TX8AJ669OtherBCBS SOLO NUMBER
TXTXB125150Medicare PIN
TX133607508Medicaid
TX0025BCMedicare PIN