Provider Demographics
NPI:1528032547
Name:HARRIS, DAVID A (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S. HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-768-9914
Mailing Address - Fax:321-953-1893
Practice Address - Street 1:2222 S. HARBOR CITY BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-768-9914
Practice Address - Fax:321-953-1893
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102926363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120074600Medicaid
FLP00400300OtherMEDICARE RAILROAD
FLQ23305Medicare UPIN