Basic Information
| Provider Information | |||||||||
| NPI: | 1528066321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARNER | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | DELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3883 AIRWAY DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954031670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075218809 | ||||||||
| FaxNumber: | 7075218835 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 SNYDER LN | ||||||||
| Address2: | STE A | ||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075858347 | ||||||||
| FaxNumber: | 7075858056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G29415 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080070430 | 01 | CA | RAILROAD MEDICARE | OTHER | 00G294150 | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER | 00G294150 | 05 | CA | MEDICAID |