Healthcare Provider Details

I. General information

NPI: 1003175977
Provider Name (Legal Business Name): KEVAN BING HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MADISON AVE SUITE 1031
MEMPHIS TN
38103-3403
US

IV. Provider business mailing address

920 MADISON AVE SUITE 212
MEMPHIS TN
38103-3438
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5364
  • Fax: 901-448-6182
Mailing address:
  • Phone: 901-448-2302
  • Fax: 901-448-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: