Healthcare Provider Details

I. General information

NPI: 1306318993
Provider Name (Legal Business Name): PAUL TRAVIS HARMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 S PECOS RD STE 2700
HENDERSON NV
89074-7198
US

IV. Provider business mailing address

100 PETTSWOOD DR
HENDERSON NV
89002-3389
US

V. Phone/Fax

Practice location:
  • Phone: 702-680-1526
  • Fax:
Mailing address:
  • Phone: 801-739-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: