Healthcare Provider Details

I. General information

NPI: 1013583269
Provider Name (Legal Business Name): HARRIS TOM JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S MAIN ST STE 130
JAMESTOWN NY
14701-6626
US

IV. Provider business mailing address

15 S MAIN ST STE 130
JAMESTOWN NY
14701-6626
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-7725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number342472-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: