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General NPI Number Information
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NPI Number | 1134105968
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Entity Type | Individual
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Provider Name | MATTHEW R HARRIS DO
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1272 W MAIN ST STE 503
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City | NEWARK
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State | OH
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Zip | 43055-2058
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Country | US
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Telephone | 220-564-1778
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Fax | 220-564-1779
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Provider Business Mailing Address
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Address Line | 1272 W MAIN ST STE 503
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City | NEWARK
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State | OH
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Zip | 43055-2058
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Country | US
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Telephone | 220-564-1778
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Fax | 220-564-1779
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.008347
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License Number State | OH
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