Healthcare Provider Details

I. General information

NPI: 1184696288
Provider Name (Legal Business Name): LAWRENCE L HARMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 LEE AVE N MAIL STOP 31400A
BROOKLYN CENTER MN
55429-1717
US

IV. Provider business mailing address

PO BOX 1309 MAILSTOP 21110Q
MINNEAPOLIS MN
55440-1309
US

V. Phone/Fax

Practice location:
  • Phone: 763-569-0300
  • Fax: 763-569-0311
Mailing address:
  • Phone: 952-883-7961
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3H94
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number44331
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: