Healthcare Provider Details

I. General information

NPI: 1679559926
Provider Name (Legal Business Name): ROGER JOHN HARRIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO DR TRACEN CAPE MAY-MEDICAL
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

15100 RESCUE WAY
CLEARWATER FL
33762
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6261
  • Fax: 609-898-6962
Mailing address:
  • Phone: 727-535-1437
  • Fax: 727-535-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: