Provider Demographics
NPI:1205179306
Name:HARRIS, JUSTIN ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3900 CLARK RD
Mailing Address - Street 2:STE H1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2366
Mailing Address - Country:US
Mailing Address - Phone:941-926-1600
Mailing Address - Fax:941-926-1166
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:STE H1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2366
Practice Address - Country:US
Practice Address - Phone:941-926-1600
Practice Address - Fax:941-926-1166
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15448208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice