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General NPI Number Information
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NPI Number | 1902024060
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Entity Type | Organization
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Legal Business Name | S ROBERT HARLA DO PA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 2321 IRA E WOODS AVE SUITE 180
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City | GRAPEVINE
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State | TX
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Zip | 76051-8632
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Country | US
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Telephone | 817-329-2263
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Fax | 817-329-3793
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Provider Business Mailing Address
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Address Line | 2321 IRA E WOODS AVE SUITE 180
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City | GRAPEVINE
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State | TX
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Zip | 76051-8632
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Country | US
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Telephone | 817-329-2263
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Fax | 817-329-3793
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Authorized Official
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Title or Position | PRESIDENT- OWNER
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Name | DR. S ROBERT HARLA
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Credential | D.O.
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Telephone | 817-329-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | J2053
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License Number State | TX
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