MEDICARE: PAUL C. 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	2084N0400X	Neurology Physician	G8162	TX

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	8BW970	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1982614251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL C. HARRIS M.D.

Provider Business Mailing Address
First Line	:	1122 KATELYN CT
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75060
Country	:	US
Telephone Number	:	325-668-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-5611
Country	:	US
Telephone Number	:	325-658-1511
Fax Number	:	325-659-0180

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	05/16/2016

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