Provider Demographics
NPI:1114092897
Name:HARRIS, CRAIG DYER (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:DYER
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 1:130 EAST THIRD NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-873-5606
Mailing Address - Fax:843-873-8861
Practice Address - Street 1:130 EAST THIRD NORTH STREET
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-873-5606
Practice Address - Fax:843-873-8861
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC166352081P2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice