MEDICARE: DR. LESLIE HARRIS JR. 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	00023925	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	636005396005	OTHER		HUMANA GOLD CHOICE 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	7200716	OTHER		AETNA
4	051504697	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1891755971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE HARRIS JR. MD

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:	334-747-4159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 E SOUTH BLVD
Second Line	:	SUITE 202
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2002
Country	:	US
Telephone Number	:	334-747-7575
Fax Number	:	334-747-7590

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	01/11/2023

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Directions to “ DR. LESLIE HARRIS JR. MD” Practice Location

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