Provider Demographics
NPI:1962615708
Name:HARRIS, DAMION M (MD)
Entity type:Individual
Prefix:DR
First Name:DAMION
Middle Name:M
Last Name:HARRIS
Suffix:
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:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:765-521-7385
Mailing Address - Fax:765-521-7394
Practice Address - Street 1:2200 FOREST RIDGE PKWY
Practice Address - Street 2:SUITE #240
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-521-7385
Practice Address - Fax:765-521-7394
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-047538207X00000X
IN01066167A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200963570Medicaid
IN220890VMedicare PIN