MEDICARE: ELIZABETH ANNE HARRIS PA C

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	363A00000X	Physician Assistant	PA672	OK

General Provider Information

NPI Number	:	1457359473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE HARRIS PA C

Provider Business Mailing Address
First Line	:	2756 LANCASTER LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4417
Country	:	US
Telephone Number	:	405-271-4646
Fax Number	:	405-271-4242

Provider Business Practice Location Address
First Line	:	7301 N COMANCHE AVE
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6698
Country	:	US
Telephone Number	:	405-271-4646
Fax Number	:	405-271-4242

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/31/2013

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