Provider Demographics
NPI:1598251142
Name:HARRIS, JONATHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13657 W MCDOWELL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2603
Mailing Address - Country:US
Mailing Address - Phone:623-748-9165
Mailing Address - Fax:623-748-9734
Practice Address - Street 1:13657 W MCDOWELL RD STE 207
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2603
Practice Address - Country:US
Practice Address - Phone:623-748-9165
Practice Address - Fax:623-748-9734
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty