Provider Demographics
NPI:1679550073
Name:HARRIS, KATHRYN AZ (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:AZ
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 N 115TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8414
Mailing Address - Country:US
Mailing Address - Phone:206-362-8337
Mailing Address - Fax:206-365-4398
Practice Address - Street 1:1560 N 115TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-362-8337
Practice Address - Fax:206-365-4398
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00384160OtherRAILROAD MEDICARE
WA1094333Medicaid
WAMD00019849OtherMD LICENSE
WAMD00019849OtherMD LICENSE
WAG8864671Medicare PIN