Provider Demographics
NPI:1538191408
Name:HARRIS, DARRELL V (MD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:V
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DARRELL
Other - Middle Name:VANCE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2632 EDITH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3043
Mailing Address - Country:US
Mailing Address - Phone:530-242-1227
Mailing Address - Fax:530-242-6078
Practice Address - Street 1:2632 EDITH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-242-1227
Practice Address - Fax:530-242-6078
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573560Medicare ID - Type Unspecified
CAA53269Medicare UPIN