Doctor Name: | KEITH W HARLESS |
NPI Number: | 1053356535 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MD08626 |
Business Practice Address: | 2275 Ne Doctors Dr Suite 5 Bend, OR - 977016324 |
Business Phone Number: | 5417067715 |
Business Fax Number: | 5415983492 |
Mailing Address: | Po Box 5579, BEND |
State: | OR |
Postal Code: | 977085579 |
Phone Number: | 5417067715 |
Fax Number: | 5415983492 |
NPI Enumeration Date: | 06/18/2006 |
NPI Last Update Date: | 11/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD08626 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |