Healthcare Provider Details

I. General information

NPI: 1245675016
Provider Name (Legal Business Name): BRIAN A HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 COLUMBIA ST
ORLANDO FL
32806-1106
US

IV. Provider business mailing address

83 COLUMBIA ST
ORLANDO FL
32806-1106
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-9340
  • Fax: 321-841-9344
Mailing address:
  • Phone: 321-841-9340
  • Fax: 321-841-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME141133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: