Provider Demographics
NPI:1528066321
Name:HARNER, REX DELL (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:DELL
Last Name:HARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3883 AIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1670
Mailing Address - Country:US
Mailing Address - Phone:707-521-8809
Mailing Address - Fax:707-521-8835
Practice Address - Street 1:5300 SNYDER LN
Practice Address - Street 2:STE A
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2915
Practice Address - Country:US
Practice Address - Phone:707-585-8347
Practice Address - Fax:707-585-8056
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG29415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080070430OtherRAILROAD MEDICARE
CA00G294150OtherBLUE SHIELD OF CALIFORNIA
CA00G294150Medicaid
CA080070430OtherRAILROAD MEDICARE
CA00G294151Medicare PIN