Provider Demographics
NPI:1912948332
Name:HARN, BEVERLY RAE (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:RAE
Last Name:HARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:509-942-2159
Practice Address - Fax:509-942-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00029869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003749200Medicaid
WA0216272OtherLIWA
WA3045HAOtherBSWA
WA3045HAOtherBSWA
WAG8144693Medicare PIN
ORR133492Medicare PIN