Provider Demographics
NPI:1700841186
Name:HARRIS, JEREMY NILES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:NILES
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 1:8013 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7222
Mailing Address - Country:US
Mailing Address - Phone:904-645-3678
Mailing Address - Fax:
Practice Address - Street 1:3636 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4223
Practice Address - Country:US
Practice Address - Phone:904-448-3387
Practice Address - Fax:904-448-3329
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics