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General NPI Number Information
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NPI Number | 1043359003
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Entity Type | Individual
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Provider Name | LEO TIMOTHY HARRIS III PA
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 300 NE 57TH ST
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City | MIAMI
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State | FL
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Zip | 33137-2543
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Country | US
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Telephone | 305-610-1504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102129
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License Number State | FL
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