Provider Demographics
NPI:1275396160
Name:HARRIS, JOHN MEREDITH (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MEREDITH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:GLENBROOK
Mailing Address - State:NV
Mailing Address - Zip Code:89413-0351
Mailing Address - Country:US
Mailing Address - Phone:530-318-3878
Mailing Address - Fax:
Practice Address - Street 1:1691 MICHAEL LN
Practice Address - Street 2:
Practice Address - City:GLENBROOK
Practice Address - State:NV
Practice Address - Zip Code:89413
Practice Address - Country:US
Practice Address - Phone:530-318-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry