MEDICARE: DAVID HARRIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	ME61067	FL
2	207L00000X	Anesthesiology Physician	2009-00912	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14919	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013961374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HARRIS MD

Provider Business Mailing Address
First Line	:	2381 SW RACQUET CLUB DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2381 SW RACQUET CLUB DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2608
Country	:	US
Telephone Number	:	772-418-2036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/08/2016

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