Provider Demographics
NPI:1588787220
Name:SURGICAL ONCOLOGY & GENERAL SUGERY, PC
Entity type:Organization
Organization Name:SURGICAL ONCOLOGY & GENERAL SUGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-368-9826
Mailing Address - Street 1:PO BOX 30195
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1195
Mailing Address - Country:US
Mailing Address - Phone:251-368-9826
Mailing Address - Fax:251-368-3917
Practice Address - Street 1:406 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-3016
Practice Address - Country:US
Practice Address - Phone:251-368-9826
Practice Address - Fax:251-368-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X, 2086X0206X
AL9132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080702OtherMEDICARE
AL010024215OtherRR MEDICARE
AL51080702OtherBCBS
AL000080702Medicaid
AL529301280OtherMEDICAID GROUP #
AL529301280OtherMEDICAID GROUP #