Provider Demographics
NPI:1184648883
Name:HARRIS, CAROLYN ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9003 AIRPORT FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7770
Mailing Address - Country:US
Mailing Address - Phone:817-514-5262
Mailing Address - Fax:817-514-5246
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:SUITE 245
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-596-5222
Practice Address - Fax:972-596-5291
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7636Medicare ID - Type Unspecified
TXH20612Medicare UPIN