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General NPI Number Information
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NPI Number | 1265439103
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Entity Type | Individual
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Provider Name | TYLER ELLIOTT HARRIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2817 ROCK MERRITT AVE
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City | FORT LIBERTY
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State | NC
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Zip | 28310-5243
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Country | US
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Telephone | 910-907-6784
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 LAKEBAY RD
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City | VASS
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State | NC
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Zip | 28394-9532
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Country | US
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Telephone | 707-332-4153
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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 | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 207253
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License Number State | NC
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