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General NPI Number Information
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NPI Number | 1356635270
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Entity Type | Individual
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Provider Name | MARTIN J HARRIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 650 JOEL DR BLANCHFIELD ARMY COMMUNITY HOSPITAL
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City | FT.CAMPBELL
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State | KY
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Zip | 42223
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Country | US
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Telephone | 270-798-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 RUSH DR
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City | SALIDA
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State | CO
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Zip | 81201-9627
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Country | US
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Telephone | 719-530-2200
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Fax | 719-530-2469
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101252460
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License Number State | VA
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