Provider Demographics
NPI:1114119187
Name:HARRIS, ADAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
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 1:8573 E PRINCESS DR
Mailing Address - Street 2:SUITE B-215
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7819
Mailing Address - Country:US
Mailing Address - Phone:480-563-5757
Mailing Address - Fax:480-563-5851
Practice Address - Street 1:8573 E PRINCESS DR
Practice Address - Street 2:SUITE B-215
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:480-563-5757
Practice Address - Fax:480-563-5851
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12650207RG0100X
AZ50708207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040926Medicaid
AZ758535OtherMEDICAID GRP
AZZ102830OtherMDCR GRP PTAN
AZZ181542Medicare PIN