Provider Demographics
NPI:1154373553
Name:HARRIS, DAVID F (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SHERIDAN ST
Mailing Address - Street 2:SUITE B103
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2931
Mailing Address - Country:US
Mailing Address - Phone:360-379-8031
Mailing Address - Fax:360-385-0418
Practice Address - Street 1:915 SHERIDAN ST
Practice Address - Street 2:SUITE B103
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2931
Practice Address - Country:US
Practice Address - Phone:360-379-8031
Practice Address - Fax:360-385-0418
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8805361OtherMEDICARE RHC
WA8400681Medicaid
WAG8805361Medicare ID - Type Unspecified
WAI10881Medicare UPIN