Healthcare Provider Details

I. General information

NPI: 1356635270
Provider Name (Legal Business Name): MARTIN J HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR BLANCHFIELD ARMY COMMUNITY HOSPITAL
FT.CAMPBELL KY
42223
US

IV. Provider business mailing address

1000 RUSH DR
SALIDA CO
81201-9627
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8400
  • Fax:
Mailing address:
  • Phone: 719-530-2200
  • Fax: 719-530-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101252460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: