Provider Demographics
NPI:1447270426
Name:HARSTON, RICHARD BAIRD (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BAIRD
Last Name:HARSTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:840 S PARKCREST ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8839
Mailing Address - Country:US
Mailing Address - Phone:480-635-8440
Mailing Address - Fax:480-635-8440
Practice Address - Street 1:15150 N HAYDEN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2514
Practice Address - Country:US
Practice Address - Phone:480-323-1880
Practice Address - Fax:480-905-1136
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant