Healthcare Provider Details

I. General information

NPI: 1942204375
Provider Name (Legal Business Name): GARY L. HARKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 JOHNSON AVE STE 201
SAN LUIS OBISPO CA
93401-4169
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 201
SAN LUIS OBISPO CA
93401-4169
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-5577
  • Fax: 805-595-3231
Mailing address:
  • Phone: 805-543-5577
  • Fax: 805-595-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG25721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: