Provider Demographics
NPI:1063637965
Name:DONALD P HARRELL MD
Entity type:Organization
Organization Name:DONALD P HARRELL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-294-5731
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33045-5576
Mailing Address - Country:US
Mailing Address - Phone:305-294-5731
Mailing Address - Fax:305-294-5756
Practice Address - Street 1:1111 12TH ST STE 109
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4087
Practice Address - Country:US
Practice Address - Phone:305-294-5731
Practice Address - Fax:305-294-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87462174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9665Medicare PIN
FL0711100002Medicare NSC