Healthcare Provider Details

I. General information

NPI: 1881991552
Provider Name (Legal Business Name): PAUL D HARRIS DM(P), ND, CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 804
TULSA OK
74136-7823
US

IV. Provider business mailing address

6465 S YALE AVE STE 804
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-551-6600
  • Fax:
Mailing address:
  • Phone: 918-551-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2855482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: