Healthcare Provider Details

I. General information

NPI: 1215236294
Provider Name (Legal Business Name): MICHAEL CARLOS HARRIS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 FORT CLARKE BLVD APT. 11-108
GAINESVILLE FL
32606-7182
US

IV. Provider business mailing address

1505 FORT CLARKE BLVD APT. 11-108
GAINESVILLE FL
32606-7182
US

V. Phone/Fax

Practice location:
  • Phone: 352-381-8381
  • Fax: 352-338-1910
Mailing address:
  • Phone: 352-381-8381
  • Fax: 352-338-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT8770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: