MEDICARE: DR. GARNET R HARRIS MD

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	01029733	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080114205	OTHER	IN	MEDICARE RAILROAD
6	M400029295	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10782527	OTHER	IN	CAQH
4	000000092260	OTHER	IN	BLUE CROSS BLUE SHIELD
5	4289645	OTHER	IN	AETNA

General Provider Information

NPI Number	:	1740283415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARNET R HARRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 390
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122
Country	:	US
Telephone Number	:	317-718-0044
Fax Number	:	317-745-5219

Provider Business Practice Location Address
First Line	:	7 MANOR DR
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122
Country	:	US
Telephone Number	:	317-718-0044
Fax Number	:	317-745-5219

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/07/2010

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