Healthcare Provider Details

I. General information

NPI: 1205819349
Provider Name (Legal Business Name): ROBERT HARFORD M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E LATHAM AVE SUITE 3
HEMET CA
92543-4370
US

IV. Provider business mailing address

750 E LATHAM AVE SUITE 3
HEMET CA
92543-4370
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-2272
  • Fax: 951-766-7653
Mailing address:
  • Phone: 951-658-2272
  • Fax: 951-766-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG86180
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG86180
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG86180
License Number StateCA

VIII. Authorized Official

Name: ROBERT HARFORD
Title or Position: PRESIDENT
Credential: MD
Phone: 951-658-2272