Provider Demographics
NPI:1255332722
Name:HARRIS, NORMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
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 1:617 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4525
Mailing Address - Country:US
Mailing Address - Phone:432-337-2628
Mailing Address - Fax:432-337-1737
Practice Address - Street 1:617 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4525
Practice Address - Country:US
Practice Address - Phone:432-337-2628
Practice Address - Fax:432-337-1737
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PP6ZMedicare ID - Type Unspecified
C16643Medicare UPIN