Provider Demographics
NPI:1770663973
Name:HARRIS, DESIREE A (MD)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3131 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2007
Practice Address - Country:US
Practice Address - Phone:817-375-1413
Practice Address - Fax:817-261-0013
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX137283105Medicaid
TX1976990OtherFIRSTHEALTH PIN
TX2165972OtherUHC PIN
TX86993GOtherBCBSTX IND PIN
TX9210549OtherPHCS PIN
TX9780980OtherCIGNA PIN
TX7326313OtherAETNA PIN
TXHARD462538OtherCCHIP PIN
TX148931201Medicaid
1750369203OtherGRP NPI NUMBER
TX140442880Medicaid
TX00T17KMedicare PIN
TX9780980OtherCIGNA PIN
TX148931201Medicaid