Healthcare Provider Details

I. General information

NPI: 1033380308
Provider Name (Legal Business Name): JOHN E HARRIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE SUITE 5C
PINE BLUFF AR
71603-6940
US

IV. Provider business mailing address

1801 W 40TH AVE SUITE 5C
PINE BLUFF AR
71603-6940
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-0202
  • Fax: 870-534-8836
Mailing address:
  • Phone: 870-534-0202
  • Fax: 870-534-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1963
License Number StateAR

VIII. Authorized Official

Name: DR. JOHN E HARRIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 870-534-0202