MEDICARE: THOMAS D HARRIS MD PA

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	261QP2300X	Primary Care Clinic/Center	ME0059581	FL

General Provider Information

NPI Number	:	1760677702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS D HARRIS MD PA

Provider Business Mailing Address
First Line	:	5900 TURKEY LAKE RD
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:	407-351-9696
Fax Number	:	407-351-8848

Provider Business Practice Location Address
First Line	:	5900 TURKEY LAKE RD
Second Line	:	STE. A
City	:	ORLANDO
State	:	FL
Zip	:	32819-4216
Country	:	US
Telephone Number	:	407-351-9696
Fax Number	:	407-351-8848

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	THOMAS D HARRIS
Credential	:	M.D.
Telephone Number	:	407-351-9696

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	08/31/2016

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