MEDICARE: DR. MATHESON ADAMS HARRIS M.D.

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	207W00000X	Ophthalmology Physician	23582	WV
2	207W00000X	Ophthalmology Physician	7928404-1205	UT

General Provider Information

NPI Number	:	1912110230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATHESON ADAMS HARRIS M.D.

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:	SUITE 130
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-264-4420
Fax Number	:	801-266-0604

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:	SUITE 130
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-264-4420
Fax Number	:	801-266-0604

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	12/20/2021

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