Provider Demographics
NPI:1396849691
Name:HARRIS, MICHAEL BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BERNARD
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 1:12234 PANAMA CITY BEACH PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2726
Mailing Address - Country:US
Mailing Address - Phone:850-233-2323
Mailing Address - Fax:850-233-1055
Practice Address - Street 1:12234 PANAMA CITY BEACH PKWY STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2726
Practice Address - Country:US
Practice Address - Phone:850-233-2323
Practice Address - Fax:850-233-1055
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110323207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58926OtherFLORIDA BLUE (BCBSFL)
FL004001500Medicaid
FLH43306Medicare UPIN
FL58926ZMedicare PIN