Healthcare Provider Details

I. General information

NPI: 1023066263
Provider Name (Legal Business Name): ROBERT C. HARVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEIDELBERG MEDDAC CMR 442
APO AE
09042
DE

IV. Provider business mailing address

ATTN: CREDENTIALS OFFICE CMR 442
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 011496221172274
  • Fax: 011496221172941
Mailing address:
  • Phone: 011496221172274
  • Fax: 011496221172941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00015515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: