Provider Demographics
NPI:1306847090
Name:HARRIS, DONALD E (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
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 1:3535 SELLERS DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-9719
Mailing Address - Country:US
Mailing Address - Phone:740-344-1320
Mailing Address - Fax:740-344-9407
Practice Address - Street 1:1320 GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7500
Practice Address - Country:US
Practice Address - Phone:740-344-1320
Practice Address - Fax:740-344-9407
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 004545208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701619Medicaid
OHE00772Medicare UPIN
OH0701619Medicaid