MEDICARE: BENJAMIN K. HARRIS KEITH 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	207RR0500X	Rheumatology Physician	5818	AZ

General Provider Information

NPI Number	:	1356316368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN K. HARRIS KEITH HARRIS M.D.

Provider Business Mailing Address
First Line	:	512 E STELLA LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1172
Country	:	US
Telephone Number	:	602-263-9294
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 E MCDOWELL RD
Second Line	:	SUITE 206
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2503
Country	:	US
Telephone Number	:	602-253-9223
Fax Number	:	602-253-9790

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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