MEDICARE: DR. TYLER ELLIOTT 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
1	207XS0106X	Orthopaedic Hand Surgery Physician	207253	NC

General Provider Information

NPI Number	:	1265439103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER ELLIOTT HARRIS M.D.

Provider Business Mailing Address
First Line	:	2929 LAKEBAY RD
Second Line	:
City	:	VASS
State	:	NC
Zip	:	28394-9532
Country	:	US
Telephone Number	:	707-332-4153
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-5243
Country	:	US
Telephone Number	:	910-907-6784
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/09/2024

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