1992736375 NPI number — MR. RICHARD LEE HARVEY PA-C

Table of content: (NPI 1790567030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992736375 NPI number — MR. RICHARD LEE HARVEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARVEY
Provider First Name:
RICHARD
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992736375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 S DAHLIA CIR
Provider Second Line Business Mailing Address:
E-102
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80246-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-638-2414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 CLERMONT ST
Provider Second Line Business Practice Location Address:
SURGICAL SERVICE UNIT -112 (ORTHO)
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80220-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-399-8020
Provider Business Practice Location Address Fax Number:
303-393-5144
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C0003069 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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