1033388061 NPI number — DR. CLYDE D HARMON JR.

Table of content: DR. CLYDE D HARMON JR. (NPI 1033388061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033388061 NPI number — DR. CLYDE D HARMON JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
CLYDE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RORRER
Provider Other First Name:
VALERIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
CA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033388061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 HANSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEREA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40403-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-986-5636
Provider Business Mailing Address Fax Number:
859-986-9124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE#1
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40403-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-986-5636
Provider Business Practice Location Address Fax Number:
859-986-9124
Provider Enumeration Date:
02/24/2008

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: 111N00000X , with the licence number:  4157 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 85002053 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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