Provider Demographics
NPI:1528172327
Name:H ROSS HARRIS MD PA
Entity type:Organization
Organization Name:H ROSS HARRIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-596-1848
Mailing Address - Street 1:9090 PARK ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9616
Mailing Address - Country:US
Mailing Address - Phone:239-936-3344
Mailing Address - Fax:239-936-5126
Practice Address - Street 1:5415 PARK CENTRAL CT
Practice Address - Street 2:BLDING D
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-5934
Practice Address - Country:US
Practice Address - Phone:239-596-1848
Practice Address - Fax:239-596-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF49051Medicare UPIN