Healthcare Provider Details

I. General information

NPI: 1518071471
Provider Name (Legal Business Name): MARNA RACENE HARRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARNA RACENE SMITH M.D.

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 N 87TH ST STE 102
SCOTTSDALE AZ
85260-3687
US

IV. Provider business mailing address

14301 N 87TH ST STE 102
SCOTTSDALE AZ
85260-3687
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-8188
  • Fax: 480-351-8187
Mailing address:
  • Phone: 480-351-8188
  • Fax: 480-351-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.121054
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43522
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0052234
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD423192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: