Healthcare Provider Details

I. General information

NPI: 1063443901
Provider Name (Legal Business Name): TODD J HARRIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD SUITE 4400
BOZEMAN MT
59715-6904
US

IV. Provider business mailing address

FAMILY MEDICINE CLINIC 935 HIGHLAND BLVD STE 2200
BOZEMAN MT
59715-6915
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-5123
  • Fax: 406-556-6758
Mailing address:
  • Phone: 406-414-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8230
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: