Provider Demographics
NPI:1316136633
Name:LAURI A HARSH
Entity type:Organization
Organization Name:LAURI A HARSH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:563-355-7602
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 116
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-355-7602
Mailing Address - Fax:563-355-7606
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 116
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-355-7602
Practice Address - Fax:563-355-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3533207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty