MEDICARE: S ROBERT HARLA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	J2053	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00998010	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8FC810	OTHER	TX	BCBS PV#
4	8AJ669	OTHER	TX	BCBS SOLO NUMBER

General Provider Information

NPI Number	:	1740250695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S ROBERT HARLA D.O.

Provider Business Mailing Address
First Line	:	3500 JEFFERSON ST
Second Line	:	STE 200
City	:	AUSTIN
State	:	TX
Zip	:	78731-6200
Country	:	US
Telephone Number	:	512-451-0139
Fax Number	:	512-323-5880

Provider Business Practice Location Address
First Line	:	160 CREEKSIDE PARK RD
Second Line	:	STE 300
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6150
Country	:	US
Telephone Number	:	512-451-0139
Fax Number	:	512-323-5880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/31/2017

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Directions to “ S ROBERT HARLA D.O.” Practice Location

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