Provider Demographics
NPI:1285998484
Name:HARRIS, JORDAN ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2251
Mailing Address - Country:US
Mailing Address - Phone:801-768-8800
Mailing Address - Fax:801-820-8200
Practice Address - Street 1:62 E THRIVE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5558
Practice Address - Country:US
Practice Address - Phone:801-768-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9557457-1204207N00000X, 207N00000X
UT95574571204208D00000X
MI5101021192390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program