MEDICARE: DR. ROY 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	207Q00000X	Family Medicine Physician	A52578	CA

General Provider Information

NPI Number	:	1467589333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY HARRIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 472
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91209-0472
Country	:	US
Telephone Number	:	818-364-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	14445 OLIVE VIEW DR
Second Line	:	NORTH ANNEX
City	:	SYLMAR
State	:	CA
Zip	:	91342-1437
Country	:	US
Telephone Number	:	818-364-3244
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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