Provider Demographics
NPI:1578560751
Name:HARRIS, HAROLD SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:SCOTT
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 1:2721 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5781
Mailing Address - Country:US
Mailing Address - Phone:239-772-3636
Mailing Address - Fax:239-772-8903
Practice Address - Street 1:2721 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 200
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5781
Practice Address - Country:US
Practice Address - Phone:239-772-3636
Practice Address - Fax:239-772-8903
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044709207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047741900Medicaid
FL2499168OtherGHI
FL4091386OtherAETNA
FLP00100202OtherRAILROAD MEDICARE
FL05658OtherBCBS
FL204675OtherAVMED
FL2499168OtherGHI
FLP00100202OtherRAILROAD MEDICARE