Provider Demographics
NPI:1255306841
Name:HARRIS, WILLIE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:GEORGE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:JAMES .A. HALEY VA HOSPITAL
Mailing Address - Street 2:13000 BRUCE B. DOWNS BLVD.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-979-3615
Practice Address - Street 1:JAMES .A. HALEY VA HOSPITAL
Practice Address - Street 2:13000 BRUCE B. DOWNS BLVD.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-979-3615
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME32100207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2-30510Medicare PIN