Provider Demographics
NPI:1609972686
Name:DANIEL C HARRIS, M.D. PC
Entity Type:Organization
Organization Name:DANIEL C HARRIS, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-223-3213
Mailing Address - Street 1:2002 12TH AVE NW STE E
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1206
Mailing Address - Country:US
Mailing Address - Phone:580-223-3216
Mailing Address - Fax:580-223-4184
Practice Address - Street 1:2002 12TH AVE NW STE E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-223-3216
Practice Address - Fax:580-223-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23380174400000X
TXK8632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23380OtherLICENSE
OK1831149210OtherNPI - INDIVIDUAL
TXK8632OtherLICENSE
OKH07984Medicare UPIN