Provider Demographics
NPI:1407292907
Name:HARRIS, MARVIN K JR (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:K
Last Name:HARRIS
Suffix:JR
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 1:4220 N DEL CIERVO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1832
Mailing Address - Country:US
Mailing Address - Phone:206-229-1402
Mailing Address - Fax:
Practice Address - Street 1:4220 N DEL CIERVO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1832
Practice Address - Country:US
Practice Address - Phone:206-229-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-12
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52249207P00000X, 207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine