Provider Demographics
NPI:1740402858
Name:HARRIS, SCOTT SIDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:SIDNEY
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 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-863-2000
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:301 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4113
Practice Address - Country:US
Practice Address - Phone:218-863-2000
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5107208600000X, 208D00000X
MN28934208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15107OtherMEDICAID
ND15107Medicaid
MN1740402858Medicaid
ND14688Medicaid
NDCF8850OtherRAILROAD MEDICARE
NDP00806459OtherRAILROAD MEDICARE
NDCF8850OtherRAILROAD MEDICARE
NDN714750Medicare Oscar/Certification
MN010000427Medicare PIN
ND15107OtherMEDICAID
NDN714764Medicare PIN
ND717546Medicare PIN