=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407844236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD R HARRIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SAINT VINCENT CIR CARTI- MARKHAM & UNIVERSITY
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-296-3273
-----------------------------------------------------
Fax | 501-664-8721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56409
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72215-6409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-296-3273
-----------------------------------------------------
Fax | 501-664-8721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | C3082
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------