Basic Information
Provider Information
NPI: 1053607549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARMON
FirstName: LAURA
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9049
Address2:  
City: BOULDER
State: CO
PostalCode: 803019049
CountryCode: US
TelephoneNumber: 3034432123
FaxNumber: 3034439497
Practice Location
Address1: 4743 ARAPAHOE AVE STE 100
Address2:  
City: BOULDER
State: CO
PostalCode: 803031123
CountryCode: US
TelephoneNumber: 3034432123
FaxNumber: 3034439497
Other Information
ProviderEnumerationDate: 06/22/2011
LastUpdateDate: 09/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X559677TXN Allopathic & Osteopathic PhysiciansSurgery 
2086S0127XDR.0059751COY Allopathic & Osteopathic PhysiciansSurgeryTrauma Surgery

No ID Information.


Home