Individual
GARTH HOWLAND HARLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1530 BESSIE AVE, SUITE 108, TRACY, CA 95376-3080
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G68992
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G689920
BLUE SHIELD
CA
05
—
00G689920
—
CA
Enumeration date
10/24/2005
Last updated
01/28/2008
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