MEDICARE: DR. ETHAN DANIEL 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	61661791	WA

General Provider Information

NPI Number	:	1881188563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN DANIEL HARRIS MD

Provider Business Mailing Address
First Line	:	420 NE 72ND ST STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-5479
Country	:	US
Telephone Number	:	206-297-5077
Fax Number	:	425-648-5485

Provider Business Practice Location Address
First Line	:	420 NE 72ND ST STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-5479
Country	:	US
Telephone Number	:	206-297-5077
Fax Number	:	425-648-5485

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	01/16/2026

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