Provider Demographics
NPI:1225025182
Name:HARRIS, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7212
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2141 LOCH RANE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-427-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1108014OtherCARE PLUS HEALTH PLANS
FL252340000Medicaid
FL225221OtherAVMED
FLP01327656OtherRR MEDICARE
FL684702OtherWELLCARE
FLP982978OtherFREEDOM HEALTH
FL1193110OtherWELLCARE
FL41406OtherBC BS
FLP0026504OtherFLORIDA HEALTHCARE PLUS
FLP01593276OtherRR MEDICARE
FL5385643OtherAETNA
FL41406OtherBC BS
FL41406NMedicare PIN
FL41406MMedicare PIN
FLP01327656OtherRR MEDICARE
FL1193110OtherWELLCARE
FLP01026579Medicare PIN
FL252340000Medicaid