Provider Demographics
NPI:1225075302
Name:HARRIS, ALAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
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 1:1370 BOSSLER LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7128
Mailing Address - Country:US
Mailing Address - Phone:618-304-1158
Mailing Address - Fax:618-624-4934
Practice Address - Street 1:VA ST. LOUIS MEDICAL CENTER
Practice Address - Street 2:915 NORTH GRAND BLVD.
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360939452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360939452Medicaid
TN1355486OtherBCBS OF TN
ILP00088416Medicare ID - Type UnspecifiedRR
ILK00496Medicare ID - Type Unspecified
TN1355486OtherBCBS OF TN