MEDICARE: DR. CAMILLE ELIZABETH HARRIS DPM

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	213E00000X	Podiatrist	DP00359	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00251554	OTHER	OR	RAILROAD MEDICARE
5	4540570001	OTHER	OR	MEDICARE DMERC
6	P00251554	OTHER	ID	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
3	861141948	OTHER	OR	TAX ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538164108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE ELIZABETH HARRIS DPM

Provider Business Mailing Address
First Line	:	1105 E USTICK RD
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-6306
Country	:	US
Telephone Number	:	208-402-6587
Fax Number	:	208-402-6578

Provider Business Practice Location Address
First Line	:	1105 E USTICK RD
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605
Country	:	US
Telephone Number	:	208-463-7732
Fax Number	:	541-889-4736

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/17/2018

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Directions to “ DR. CAMILLE ELIZABETH HARRIS DPM” Practice Location

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