Provider Demographics
NPI:1538132121
Name:HARRIS, LEE S (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:S
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 1:2881 HYDE PARK ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3228
Mailing Address - Country:US
Mailing Address - Phone:941-366-2460
Mailing Address - Fax:941-366-3015
Practice Address - Street 1:2881 HYDE PARK ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3228
Practice Address - Country:US
Practice Address - Phone:941-366-2460
Practice Address - Fax:941-366-3015
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME11685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035329900Medicaid
FL58187TMedicare PIN
FL035329900Medicaid