Provider Demographics
NPI:1053610436
Name:JOHN P. HARRIS M.D
Entity type:Organization
Organization Name:JOHN P. HARRIS M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-272-4276
Mailing Address - Street 1:415 BIENVILLE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5700
Mailing Address - Country:US
Mailing Address - Phone:318-356-0555
Mailing Address - Fax:318-356-0660
Practice Address - Street 1:415 BIENVILLE ST STE 2
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5700
Practice Address - Country:US
Practice Address - Phone:318-356-0555
Practice Address - Fax:318-356-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D829OtherMEDICARE PTAN