MEDICARE: DR. THOMAS E. HARRIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	107345	MO
2	207Q00000X	Family Medicine Physician	C-6832	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	152003	OTHER		BLUE CROSS MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477665446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E. HARRIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1523
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72702-1523
Country	:	US
Telephone Number	:	479-571-6038
Fax Number	:	479-582-0222

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD
Second Line	:	SUITE 6
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-442-0006
Fax Number	:	479-442-3038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/13/2013

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Directions to “ DR. THOMAS E. HARRIS M.D.” Practice Location

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