MEDICARE: RYAN SCOTT HARRIS

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	390200000X	Student in an Organized Health Care Education/Training Program	903502	TX

General Provider Information

NPI Number	:	1902796204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SCOTT HARRIS

Provider Business Mailing Address
First Line	:	1309 NE 23RD ST UNIT B
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-2320
Country	:	US
Telephone Number	:	325-201-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 N 21ST AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4158
Country	:	US
Telephone Number	:	325-201-5714
Fax Number	:

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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Directions to “ RYAN SCOTT HARRIS ” Practice Location

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