Provider Demographics
NPI:1003980764
Name:HARRIS, ERIC A (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LANE
Mailing Address - Street 2:CORAL SUITE 405
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1223
Mailing Address - Country:US
Mailing Address - Phone:425-305-5182
Mailing Address - Fax:
Practice Address - Street 1:19230 ALDERWOOD MALL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4869
Practice Address - Country:US
Practice Address - Phone:425-305-5182
Practice Address - Fax:253-214-3701
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8564208600000X
WAMD60088259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60088259OtherSTATE LICENSE