Provider Demographics
NPI:1083626543
Name:HARRIS, JEFFREY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEVEN
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 1:7486 MCCONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1080
Mailing Address - Country:US
Mailing Address - Phone:310-641-7750
Mailing Address - Fax:
Practice Address - Street 1:11560 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1520
Practice Address - Country:US
Practice Address - Phone:310-477-8285
Practice Address - Fax:310-477-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30312207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A303120Medicaid
CAA26049Medicare UPIN
CAWA30312Medicare ID - Type Unspecified