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NPI Code Detail

MEDICARE: JEFFREY L HARRIS MD

MEDICARE: JEFFREY L 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
1207X00000XOrthopaedic Surgery Physician01041577AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200034548OTHERINRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689673204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY L HARRIS MD
Provider Business Mailing Address
First Line : 5052 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-482-5060
Provider Business Practice Location Address
First Line : 5050 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5886
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-408-8014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 10/30/2018

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Directions to “ JEFFREY L HARRIS MD” Practice Location

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