Provider Demographics
NPI:1780646018
Name:HARRIS, RODERICK OWEN (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:OWEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODERICK
Other - Middle Name:O
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD INC
Mailing Address - Street 1:681 MEDICAL CENTER DR W
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6803
Mailing Address - Country:US
Mailing Address - Phone:559-299-9000
Mailing Address - Fax:559-299-8581
Practice Address - Street 1:681 MEDICAL CENTER DR W
Practice Address - Street 2:SUITE #101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6803
Practice Address - Country:US
Practice Address - Phone:559-299-9000
Practice Address - Fax:559-299-8581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36995207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G369950OtherBLUE CROSS
CA00G369950Medicaid
A46902Medicare UPIN
00G369950Medicare ID - Type Unspecified