Provider Demographics
NPI:1063600815
Name:PHILIP L HARRIS, MD,PA
Entity type:Organization
Organization Name:PHILIP L HARRIS, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-809-1956
Mailing Address - Street 1:229 GEORGE BUSH BLVD.
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:561-272-1234
Mailing Address - Fax:561-274-2060
Practice Address - Street 1:229 GEORGE BUSH BLVD.
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-272-1234
Practice Address - Fax:561-274-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7376Medicare PIN