Individual
KEITH W HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2275 NE DOCTORS DR, SUITE 5, BEND, OR 97701-6324
(541) 706-7715
(541) 598-3492
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-7715
(541) 598-3492
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD08626
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234351
—
OR
01
—
290005326
RAILROAD
OR
Enumeration date
06/18/2006
Last updated
11/21/2012
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