Healthcare Provider Details

I. General information

NPI: 1891717112
Provider Name (Legal Business Name): DEBORAH G HARRIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

PO BOX 218
TELL CITY IN
47586-0218
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2100
  • Fax: 406-488-2261
Mailing address:
  • Phone: 740-706-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS8205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34007687
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6547
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2389
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number80833
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: