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NPI Code Detail

MEDICARE: ETHAN GEOFFREY HARRIS M.D.

MEDICARE: ETHAN GEOFFREY HARRIS M.D.
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
12084P0800XPsychiatry PhysicianG18727CA

General Provider Information

NPI Number : 1124011689
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN GEOFFREY HARRIS M.D.
Provider Business Mailing Address
First Line : PO BOX 999
Second Line : 13437 ANTELOPE TRAIL
City : OREGON HOUSE
State : CA
Zip : 95962-0999
Country : US
Telephone Number : 530-692-0802
Fax Number :
Provider Business Practice Location Address
First Line : 1119 E MONTE VISTA AVE
Second Line :
City : VACAVILLE
State : CA
Zip : 95688-3009
Country : US
Telephone Number : 707-469-4610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 10/07/2021

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