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General NPI Number Information
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NPI Number | 1275847394
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Entity Type | Individual
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Provider Name | MICHAEL SHANE HARRIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 3330 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3841
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Country | US
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Telephone | 318-449-2415
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Fax |
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Provider Business Mailing Address
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Address Line | 919 HIDDEN RDG
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City | IRVING
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State | TX
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Zip | 75038-3813
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Country | US
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Telephone | 469-282-2711
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Fax | 469-282-0996
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.200360
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License Number State | LA
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