MEDICARE: ELIZABETH 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208M00000X	Hospitalist Physician	TP965	KY
3	208M00000X	Hospitalist Physician	S5646	TX

General Provider Information

NPI Number	:	1417488438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HARRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 ROSE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-7709
Country	:	US
Telephone Number	:	859-323-6047
Fax Number	:	859-257-3873

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	07/01/2022

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