Basic Information
| Provider Information | |||||||||
| NPI: | 1942204375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARKINS | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 JOHNSON AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055435577 | ||||||||
| FaxNumber: | 8055953231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 JOHNSON AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055435577 | ||||||||
| FaxNumber: | 8055953231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207RH0003X | G25721 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | G25721 | 01 | CA | MEDICAL LICENSE # | OTHER | 00G257210 | 05 | CA | MEDICAID | CJ5643 | 01 | RR MEDICARE PIN | OTHER | GR0091140 | 05 | CA | MEDICAID | 2257346 | 01 | FIRST HEALTH PIN | OTHER | 1018 | 01 | CA | CMSP GRP PIN | OTHER |