Healthcare Provider Details

I. General information

NPI: 1952688392
Provider Name (Legal Business Name): MATTHEW J HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 INTRACOASTAL POINTE DRIVE SUITE 300
JUPITER FL
33477
US

IV. Provider business mailing address

108 INTRACOASTAL POINTE DRIVE SUITE 300
JUPITER FL
33477
US

V. Phone/Fax

Practice location:
  • Phone: 561-529-4494
  • Fax: 561-529-4494
Mailing address:
  • Phone: 561-529-4494
  • Fax: 561-529-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME111506
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME111506
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME111506
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME111506
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME111506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: