Healthcare Provider Details

I. General information

NPI: 1801889803
Provider Name (Legal Business Name): PAUL E. HARRIS JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NORTON RD
COLUMBUS OH
43228-1711
US

IV. Provider business mailing address

15 NORTON RD
COLUMBUS OH
43228-1711
US

V. Phone/Fax

Practice location:
  • Phone: 614-878-6455
  • Fax: 614-878-6466
Mailing address:
  • Phone: 614-878-6455
  • Fax: 614-878-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: