Provider Demographics
NPI:1437316411
Name:HARRIS, WILLIAM DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DENNIS
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 1:7126 ATASCADERO LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7460
Mailing Address - Country:US
Mailing Address - Phone:423-290-9772
Mailing Address - Fax:850-718-2894
Practice Address - Street 1:4250 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1917
Practice Address - Country:US
Practice Address - Phone:850-718-2644
Practice Address - Fax:850-718-2894
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12160207Q00000X
FL110030207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine