Provider Demographics
NPI:1740313675
Name:HARALSON, ROBERT H III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:HARALSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6300 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4206
Mailing Address - Country:US
Mailing Address - Phone:846-384-4040
Mailing Address - Fax:847-823-8028
Practice Address - Street 1:6300 N RIVER RD
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-4206
Practice Address - Country:US
Practice Address - Phone:846-384-4040
Practice Address - Fax:847-823-8028
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000005090207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB00938Medicare UPIN