Healthcare Provider Details

I. General information

NPI: 1922065788
Provider Name (Legal Business Name): WILLIAM G HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 850
ORANGE CA
92868-4218
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-7994
  • Fax: 714-744-4167
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG64493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: