Provider Demographics
NPI:1437135340
Name:HARRIS, JEFF (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
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 1:23805 STUART RANCH RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4889
Mailing Address - Country:US
Mailing Address - Phone:310-456-1981
Mailing Address - Fax:310-456-9772
Practice Address - Street 1:23805 STUART RANCH RD STE 210
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4889
Practice Address - Country:US
Practice Address - Phone:310-456-1891
Practice Address - Fax:310-456-9772
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine