Provider Demographics
NPI:1033173729
Name:DAVID M HARRIS MD
Entity Type:Organization
Organization Name:DAVID M HARRIS MD
Other - Org Name:DAVID M HARRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PRACTICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-327-2907
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0933
Mailing Address - Country:US
Mailing Address - Phone:304-327-2976
Mailing Address - Fax:304-327-2989
Practice Address - Street 1:3 WESTWOOD MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:304-327-2976
Practice Address - Fax:304-327-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13456207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101504000Medicaid
WV4102841Medicare ID - Type Unspecified
WV0101504000Medicaid