=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265620116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGG M HARRIS DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 03/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9980 CENTRAL PARK BLVD N STE 106
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-488-3338
-----------------------------------------------------
Fax | 561-488-1540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9980 CENTRAL PARK BLVD N STE 106
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-488-3338
-----------------------------------------------------
Fax | 561-488-1540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT PA
-----------------------------------------------------
Name | DR. GREGG MICHAEL HARRIS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 561-488-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO 0001441
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------