Provider Demographics
NPI:1689994527
Name:LITTLEROCK FAMILY MEDICINE, P.S.
Entity type:Organization
Organization Name:LITTLEROCK FAMILY MEDICINE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-943-3633
Mailing Address - Street 1:6981 LITTLEROCK RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7226
Mailing Address - Country:US
Mailing Address - Phone:360-943-3633
Mailing Address - Fax:360-528-4643
Practice Address - Street 1:6981 LITTLEROCK RD SW STE 101
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7226
Practice Address - Country:US
Practice Address - Phone:360-943-3633
Practice Address - Fax:360-528-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602927476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty