Provider Demographics
NPI:1063443901
Name:HARRIS, TODD J (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FAMILY MEDICINE CLINIC
Mailing Address - Street 2:935 HIGHLAND BLVD STE 2200
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6915
Mailing Address - Country:US
Mailing Address - Phone:406-414-5700
Mailing Address - Fax:
Practice Address - Street 1:935 HIGHLAND BLVD
Practice Address - Street 2:SUITE 4400
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6904
Practice Address - Country:US
Practice Address - Phone:406-587-5123
Practice Address - Fax:406-556-6758
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT14291OtherBCBS
MT100623Medicaid
MT14291OtherBCBS
G26522Medicare UPIN