Provider Demographics
NPI:1689769853
Name:PATRICK J HARRIS D O P A
Entity Type:Organization
Organization Name:PATRICK J HARRIS D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-328-2222
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0813
Mailing Address - Country:US
Mailing Address - Phone:386-328-2222
Mailing Address - Fax:386-328-2238
Practice Address - Street 1:200 MISSION RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2618
Practice Address - Country:US
Practice Address - Phone:386-328-2222
Practice Address - Fax:386-328-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0008101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2600269-00Medicaid
FLK8789Medicare PIN
FLH16210Medicare UPIN