MEDICARE: LAWRENCE HARMON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1275526956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE HARMON MD

Provider Business Mailing Address
First Line	:	2044 MADISON AVE
Second Line	:	SUITE 23
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4641
Country	:	US
Telephone Number	:	618-451-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2044 MADISON AVE
Second Line	:	SUITE 23
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4641
Country	:	US
Telephone Number	:	618-451-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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Directions to “ LAWRENCE HARMON MD” Practice Location

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