Provider Demographics
NPI:1861676215
Name:HARRIS, JOHN MALCOLM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MALCOLM
Last Name:HARRIS
Suffix:JR
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 1:5944 E MIRAMAR DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3002
Mailing Address - Country:US
Mailing Address - Phone:520-722-1970
Mailing Address - Fax:
Practice Address - Street 1:5944 E MIRAMAR DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3002
Practice Address - Country:US
Practice Address - Phone:520-722-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine