Healthcare Provider Details

I. General information

NPI: 1245731322
Provider Name (Legal Business Name): HARLEY DAKIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 10/07/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

IV. Provider business mailing address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

V. Phone/Fax

Practice location:
  • Phone: 315-645-7372
  • Fax:
Mailing address:
  • Phone: 315-645-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: