Provider Demographics
NPI:1346259835
Name:HARRIS, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
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 1:5900 TURKEY LAKE ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4216
Mailing Address - Country:US
Mailing Address - Phone:407-351-9696
Mailing Address - Fax:407-351-8848
Practice Address - Street 1:5900 TURKEY LAKE ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4216
Practice Address - Country:US
Practice Address - Phone:407-351-9696
Practice Address - Fax:407-351-8848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12476BMedicare Oscar/Certification
FLE89693Medicare UPIN