Healthcare Provider Details

I. General information

NPI: 1437135340
Provider Name (Legal Business Name): JEFF HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUCIAN JEFFERSON HARRIS III MD

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23805 STUART RANCH RD STE 210
MALIBU CA
90265-4889
US

IV. Provider business mailing address

23805 STUART RANCH RD STE 210
MALIBU CA
90265-4889
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-1891
  • Fax: 310-456-9772
Mailing address:
  • Phone: 310-456-1981
  • Fax: 310-456-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA24797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: