Provider Demographics
NPI:1972561827
Name:HARRIS, CALEB H (MD)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:H
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 1:2237 KEYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8742
Mailing Address - Country:US
Mailing Address - Phone:316-616-6272
Mailing Address - Fax:316-616-0407
Practice Address - Street 1:2237 KEYSTONE CIR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-616-6272
Practice Address - Fax:316-616-0407
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427047208600000X
KS04-27047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111301004OtherMEDICARE ID
KS100393090BMedicaid
OK249410604Medicare PIN