Provider Demographics
NPI:1467744656
Name:HARRIS, AMBRIA KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:AMBRIA
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 E 75TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7345
Mailing Address - Country:US
Mailing Address - Phone:918-710-4200
Mailing Address - Fax:918-295-3155
Practice Address - Street 1:1441 E 75TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7345
Practice Address - Country:US
Practice Address - Phone:918-710-4200
Practice Address - Fax:918-295-3155
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine