Healthcare Provider Details

I. General information

NPI: 1588662068
Provider Name (Legal Business Name): WILLIAM KIRK HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date: 03/15/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

2870 W APACHE TRL
APACHE JUNCTION AZ
85120-5209
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-3264
  • Fax:
Mailing address:
  • Phone: 623-277-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00028579
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61656
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: