Healthcare Provider Details

I. General information

NPI: 1922066455
Provider Name (Legal Business Name): STEVEN WAYNE HARRIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST ROAD #250
LOS ALAMOS NM
87544-5302
US

IV. Provider business mailing address

1620 N MAIN ST
SPANISH FORK UT
84660-1008
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-4147
  • Fax: 505-661-4199
Mailing address:
  • Phone: 801-822-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53426961206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2011-0036
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: