MEDICARE: STEVEN WAYNE HARRIS 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	363A00000X	Physician Assistant	53426961206	UT
2	363AM0700X	Medical Physician Assistant	PA2011-0036	NM

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
2	P00084336	OTHER	UT	PALMETTO GBA

General Provider Information

NPI Number	:	1922066455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WAYNE HARRIS PA

Provider Business Mailing Address
First Line	:	1620 N MAIN ST
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-1008
Country	:	US
Telephone Number	:	801-822-2234
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 WEST ROAD #250
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-5302
Country	:	US
Telephone Number	:	505-661-4147
Fax Number	:	505-661-4199

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/14/2020

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Directions to “ STEVEN WAYNE HARRIS PA” Practice Location

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