Provider Demographics
NPI:1821162207
Name:HARRIS, WILLIAM LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-344-2451
Mailing Address - Fax:304-346-1979
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 307
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-344-2451
Practice Address - Fax:304-346-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV10537207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV042282OtherUNITED MINE WORKERS OF AM
WV001755431OtherBLUE CROSS BLUE SHILED
WV550569719001-WVOtherWV PUBLIC EMPLOYEES INS A
WV001719599OtherBLUE CROSS BLUE SHIELD
WV406083603OtherRAILROAD MEDICARE
WV406083603OtherRAILROAD MEDICARE
WV001755431OtherBLUE CROSS BLUE SHILED