Provider Demographics
NPI:1679559926
Name:HARRIS, ROGER JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
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 1:15100 RESCUE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:727-535-1437
Mailing Address - Fax:727-535-4190
Practice Address - Street 1:1 MUNRO DR
Practice Address - Street 2:TRACEN CAPE MAY-MEDICAL
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6261
Practice Address - Fax:609-898-6962
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02261363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical