Healthcare Provider Details

I. General information

NPI: 1437316411
Provider Name (Legal Business Name): WILLIAM DENNIS HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HOSPITAL DR
MARIANNA FL
32446-1917
US

IV. Provider business mailing address

7126 ATASCADERO LN
TALLAHASSEE FL
32317-7460
US

V. Phone/Fax

Practice location:
  • Phone: 850-718-2644
  • Fax: 850-718-2894
Mailing address:
  • Phone: 423-290-9772
  • Fax: 850-718-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number110030
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTRN12160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: