Healthcare Provider Details

I. General information

NPI: 1235224601
Provider Name (Legal Business Name): JOHN P. HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

450 STANYAN ST RADIOLOGY DEPT
SAN FRANCISCO CA
94117
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5687
  • Fax:
Mailing address:
  • Phone: 415-750-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA75604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA75604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: