Provider Demographics
NPI:1568675155
Name:HARRIS, MAHLON F (RT)
Entity Type:Individual
Prefix:
First Name:MAHLON
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 PENSACOLA ST
Mailing Address - Street 2:A-5
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-5817
Mailing Address - Country:US
Mailing Address - Phone:808-271-5691
Mailing Address - Fax:808-521-9454
Practice Address - Street 1:1502 PENSACOLA ST
Practice Address - Street 2:A-5
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-5817
Practice Address - Country:US
Practice Address - Phone:808-271-5691
Practice Address - Fax:808-521-9454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000250167OtherBLUE CROSS BLUE SHIELD
HI55946101Medicaid
HI55946101Medicaid