Provider Demographics
NPI:1053308270
Name:HARRIS, KURT N (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:N
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 1:3820 TAMPA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3609
Mailing Address - Country:US
Mailing Address - Phone:727-785-4540
Mailing Address - Fax:727-784-9724
Practice Address - Street 1:3820 TAMPA RD
Practice Address - Street 2:#202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3609
Practice Address - Country:US
Practice Address - Phone:727-785-4540
Practice Address - Fax:727-784-9724
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33310OtherBCBS GROUP
FL49436OtherBCBS
FL33310OtherBCBS GROUP
FL49436OtherBCBS
FL49436Medicare ID - Type UnspecifiedMEDICARE