Provider Demographics
NPI:1003254442
Name:HARRIS, TONYA (DO)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 S MERIDIAN STE B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3709
Mailing Address - Country:US
Mailing Address - Phone:253-765-5050
Mailing Address - Fax:
Practice Address - Street 1:3705 S MERIDIAN STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3709
Practice Address - Country:US
Practice Address - Phone:253-765-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60781742207QG0300X
PAOS018372207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine