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General NPI Number Information
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NPI Number | 1477521094
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Entity Type | Organization
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Legal Business Name | CLINTON J HARRIS, MD, PLC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 3600 E FULTON ST
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1322
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Country | US
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Telephone | 616-949-4971
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Fax | 616-248-3530
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Provider Business Mailing Address
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Address Line | 3600 E FULTON
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1322
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Country | US
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Telephone | 616-949-4971
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Fax | 616-248-3530
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLINTON JACOB HARRIS
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Credential | M.D.
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Telephone | 616-949-4971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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