Healthcare Provider Details

I. General information

NPI: 1932177995
Provider Name (Legal Business Name): CHRISTOPHER LEE HARRIS IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS ALASKA (SSBN 732)(BLUE)
FPO AA
34090-2111
US

IV. Provider business mailing address

USS ALASKA
FPO AA
34090-2111
US

V. Phone/Fax

Practice location:
  • Phone: 912-573-8224
  • Fax: 912-573-4534
Mailing address:
  • Phone: 912-573-8224
  • Fax: 912-573-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: