Provider Demographics
NPI:1518963529
Name:HARRIS, WILLIAM KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 502852
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-2852
Mailing Address - Country:US
Mailing Address - Phone:636-239-9011
Mailing Address - Fax:636-239-0433
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-239-9011
Practice Address - Fax:636-239-0433
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1I00207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
272481555OtherMOLINA
MO1518963529Medicaid
272481555OtherUNITED HEALTHCARE
27-2481555OtherHEALTHLINK
272481555OtherAETNA
27-2481555OtherANTHEM
272481555OtherMERCY HEALTH PLAN
272481555OtherGROUP HEALTH PLAN
MOMA2536005OtherMEDICARE
MOMA2536005OtherMEDICARE