MEDICARE: THOMAS D 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	207R00000X	Internal Medicine Physician	ME 59581	FL

General Provider Information

NPI Number	:	1346259835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS D HARRIS M.D.

Provider Business Mailing Address
First Line	:	5900 TURKEY LAKE ROAD SUITE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:	407-351-9696
Fax Number	:	407-351-8848

Provider Business Practice Location Address
First Line	:	5900 TURKEY LAKE ROAD SUITE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:	407-351-9696
Fax Number	:	407-351-8848

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/31/2016

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