Healthcare Provider Details

I. General information

NPI: 1104924109
Provider Name (Legal Business Name): DAVID PAUL HARRIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE PAIN MANAGEMENT CLINIC
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3000
  • Fax:
Mailing address:
  • Phone: 701-842-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number37745
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number210437
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number21630
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01081532A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: