Basic Information
| Provider Information | |||||||||
| NPI: | 1962764753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465287100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745340088 | ||||||||
| FaxNumber: | 5749718434 | ||||||||
| Practice Location | |||||||||
| Address1: | 808 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745340088 | ||||||||
| FaxNumber: | 5749718434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11016649A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.