=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760677702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS D HARRIS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2007
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 TURKEY LAKE RD STE. A
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-9696
-----------------------------------------------------
Fax | 407-351-8848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 TURKEY LAKE RD SUITE A
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-9696
-----------------------------------------------------
Fax | 407-351-8848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | THOMAS D HARRIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-351-9696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME0059581
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------