Healthcare Provider Details

I. General information

NPI: 1649363276
Provider Name (Legal Business Name): DONALD LEE HARMON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST H STREET
WYMORE NE
68466
US

IV. Provider business mailing address

2309 GRANT STREET
BEATRICE NE
68310
US

V. Phone/Fax

Practice location:
  • Phone: 402-645-3310
  • Fax: 402-645-3397
Mailing address:
  • Phone: 402-228-4455
  • Fax: 402-645-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number367
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: