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1487648556

NPI Code Detail

MEDICARE: DR. JOHN M HARRIS MD

MEDICARE: DR. JOHN M 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	207R00000X	Internal Medicine Physician	059919	GA
2	208M00000X	Hospitalist Physician	059919	GA
3	207R00000X	Internal Medicine Physician	ME69548	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00092310	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	650795738	OTHER		TAX ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	31536	OTHER	FL	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487648556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M HARRIS MD

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 AARON ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5305
Country	:	US
Telephone Number	:	855-979-5700
Fax Number	:	855-979-5701

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	02/06/2024

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Directions to “ DR. JOHN M HARRIS MD” Practice Location

Language	Start Address	Practice Location

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