Provider Demographics
NPI:1366636714
Name:HARRIS, DELAWARE FLOYD II (MD)
Entity Type:Individual
Prefix:
First Name:DELAWARE
Middle Name:FLOYD
Last Name:HARRIS
Suffix:II
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:POST OFFICE BOX 938
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:VA
Mailing Address - Zip Code:91353-0938
Mailing Address - Country:US
Mailing Address - Phone:310-278-3865
Mailing Address - Fax:310-271-8166
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:SUITE 321
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2111
Practice Address - Country:US
Practice Address - Phone:310-278-3865
Practice Address - Fax:310-271-8166
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392820OtherBLUE SHIELD OF CALIF
CAA39282OtherBLUE CROSS OF CALIF
CA00A392820Medicaid
CAA39282Medicare UPIN
CAA39282Medicare Oscar/Certification
CA00A392820OtherBLUE SHIELD OF CALIF