Provider Demographics
NPI:1306970595
Name:HARRIS, MICHAEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
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 1:1192 OLD TRL
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5536
Mailing Address - Country:US
Mailing Address - Phone:850-460-8727
Mailing Address - Fax:850-460-8725
Practice Address - Street 1:201 S A ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5554
Practice Address - Country:US
Practice Address - Phone:850-460-8727
Practice Address - Fax:850-460-8725
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087819208100000X
FLME109777208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00980670OtherMEDICARE RAILROAD
AL129643Medicaid
AL592-15138OtherBLUE CROSS BLUE SHIELD
FL003653200Medicaid
FL14E22OtherBLUE CROSS BLUE SHIELD
FL14E22OtherBLUE CROSS BLUE SHIELD