Provider Demographics
NPI:1063525350
Name:HARRIS, PATRICK J (D O)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740861
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0861
Mailing Address - Country:US
Mailing Address - Phone:904-819-9453
Mailing Address - Fax:904-819-4906
Practice Address - Street 1:270 PLAZA BLVD STE B5-B6
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-9305
Practice Address - Country:US
Practice Address - Phone:904-819-5150
Practice Address - Fax:904-819-5152
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0008101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2600269-00Medicaid
FL2600269-00Medicaid
H16210Medicare UPIN