Provider Demographics
NPI:1487809190
Name:HARLAN, ERIC ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALLEN
Last Name:HARLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 NW 100TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1813
Mailing Address - Country:US
Mailing Address - Phone:515-726-3376
Mailing Address - Fax:515-446-9707
Practice Address - Street 1:5705 NW 100TH ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1813
Practice Address - Country:US
Practice Address - Phone:515-726-3376
Practice Address - Fax:515-446-9707
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38780207N00000X
FLME102545207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001493000Medicaid
FLCD497ZMedicare PIN