Provider Demographics
NPI:1114139458
Name:HARRIS, PAUL DON (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DON
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-6001
Mailing Address - Country:US
Mailing Address - Phone:801-569-7401
Mailing Address - Fax:801-569-7452
Practice Address - Street 1:8362 W 10200 S
Practice Address - Street 2:
Practice Address - City:BINGHAM CANYON
Practice Address - State:UT
Practice Address - Zip Code:84006-1197
Practice Address - Country:US
Practice Address - Phone:801-569-7401
Practice Address - Fax:801-569-7452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173156-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist