Provider Demographics
NPI:1215913975
Name:HARRIS, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:6811 PALISADES PARK CT STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-533-5177
Practice Address - Fax:239-322-5610
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106641208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01193238OtherRAILROAD MCR
FL4694542OtherCIGNA
FLP986298OtherFREEDOM HEALTH
FL1193104OtherWELLCARE
FL003545700Medicaid
FL1488HOtherBCBS OF FL
FL5972493OtherAETNA
FL10P566OtherHEALTHY KIDS
FL341114OtherAVMED
FL1193104OtherWELLCARE
AL000032312Medicaid
FL341114OtherAVMED
FL1193104OtherWELLCARE
FL10P566OtherHEALTHY KIDS