Provider Demographics
NPI:1710972906
Name:HARRIS, WILLIAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
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:PO BOX 30195
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1195
Mailing Address - Country:US
Mailing Address - Phone:251-368-9826
Mailing Address - Fax:251-368-3917
Practice Address - Street 1:2305 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4191
Practice Address - Country:US
Practice Address - Phone:251-368-9826
Practice Address - Fax:251-368-3917
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.9132207P00000X, 2086X0206X, 208600000X
ALMD9132207Q00000X
AL9132208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010024215OtherRAILROAD MEDICARE
AL529301280Medicaid
AL3610053OtherUNITED HEALTHCARE
AL51080702OtherBCBS
AL51080702OtherBCBS
AL010024215OtherRAILROAD MEDICARE