Provider Demographics
NPI:1528140886
Name:HARRIS, LEE A JR (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:HARRIS
Suffix:JR
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 1:2923 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 S BUFFALO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4372
Practice Address - Country:US
Practice Address - Phone:574-267-3889
Practice Address - Fax:574-267-3249
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027478A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology