Provider Demographics
NPI:1154588416
Name:HARRIS, DAVID E (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:707 MURPHY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8520
Mailing Address - Country:US
Mailing Address - Phone:541-414-0455
Mailing Address - Fax:541-414-0450
Practice Address - Street 1:707 MURPHY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8520
Practice Address - Country:US
Practice Address - Phone:541-414-0455
Practice Address - Fax:541-414-0450
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO170508208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679386Medicaid
OR500679386Medicaid