MEDICARE: CLARISSA OLIVEIRA 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	207Q00000X	Family Medicine Physician	FLME88074	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FLME88074	OTHER	FL	MEDICAL LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891732582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA OLIVEIRA HARRIS MD

Provider Business Mailing Address
First Line	:	2700 NE 14TH STREET CSWY
Second Line	:	SUITE 103
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3561
Country	:	US
Telephone Number	:	954-942-8177
Fax Number	:	954-942-1819

Provider Business Practice Location Address
First Line	:	2700 NE 14TH STREET CSWY
Second Line	:	SUITE 103
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3561
Country	:	US
Telephone Number	:	954-942-8177
Fax Number	:	954-942-1819

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/28/2012

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