Provider Demographics
NPI:1629051685
Name:HARRIS, STUART JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JAMES
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 1:23 MARION ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-7949
Mailing Address - Country:US
Mailing Address - Phone:270-522-4060
Mailing Address - Fax:270-522-1152
Practice Address - Street 1:23 MARION ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-7949
Practice Address - Country:US
Practice Address - Phone:270-522-4060
Practice Address - Fax:270-522-1152
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29331173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64293319Medicaid
KYF63034Medicare UPIN
KY1857501Medicare ID - Type Unspecified