Provider Demographics
NPI:1619198942
Name:HARRIS, DAVID BENNER (CP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BENNER
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ORLIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3520
Mailing Address - Country:US
Mailing Address - Phone:612-331-6626
Mailing Address - Fax:
Practice Address - Street 1:2200 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 114
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1839
Practice Address - Country:US
Practice Address - Phone:651-644-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management