Provider Demographics
NPI:1699799320
Name:HARRIS, JOHN DOUGLAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:11211 ROZIER LN
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-0916
Mailing Address - Country:US
Mailing Address - Phone:813-978-5969
Mailing Address - Fax:813-972-7605
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:JAMES A. HALEY VA HOSPITAL / COMP&PEN (MAIL 11C&P)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-978-5969
Practice Address - Fax:813-972-7605
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA-1701363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical