Provider Demographics
NPI:1538454830
Name:HARLAN, RAOUL KERWIN (ATP)
Entity type:Individual
Prefix:MR
First Name:RAOUL
Middle Name:KERWIN
Last Name:HARLAN
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 S I H 35
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5100
Mailing Address - Country:US
Mailing Address - Phone:830-627-4551
Mailing Address - Fax:866-312-5074
Practice Address - Street 1:3702 S I H 35
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5100
Practice Address - Country:US
Practice Address - Phone:830-627-4551
Practice Address - Fax:866-312-5074
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1919247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other