Provider Demographics
NPI:1760452064
Name:AGIS, HARRY (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:AGIS
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 1:10000 W COLONIAL DR STE 495
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3436
Mailing Address - Country:US
Mailing Address - Phone:407-293-5944
Mailing Address - Fax:407-293-7355
Practice Address - Street 1:10000 W COLONIAL DR STE 495
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3436
Practice Address - Country:US
Practice Address - Phone:407-293-5944
Practice Address - Fax:407-293-7355
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ42667174400000X
FLME121873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08558Medicare UPIN
FLIO212ZMedicare PIN
NJ120399Medicare ID - Type Unspecified