Provider Demographics
NPI:1467420471
Name:HARRIS, BERNARD JR (IDC)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USNH GTMO BOX 27
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09589
Mailing Address - Country:US
Mailing Address - Phone:757-443-8100
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GTMO
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09589
Practice Address - Country:US
Practice Address - Phone:757-443-8100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other