Provider Demographics
NPI:1871961797
Name:HARALSON, ERIC (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:HARALSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 W TROPICANA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4927
Mailing Address - Country:US
Mailing Address - Phone:702-452-2526
Mailing Address - Fax:702-452-2525
Practice Address - Street 1:270 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7093
Practice Address - Country:US
Practice Address - Phone:702-677-3720
Practice Address - Fax:702-677-3733
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871961797Medicaid
NVP01700941OtherRAILROAD MEDICARE
NVP01700941OtherRAILROAD MEDICARE