Provider Demographics
NPI:1891717112
Name:HARRIS, DEBORAH G (DO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
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 218
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-0218
Mailing Address - Country:US
Mailing Address - Phone:740-706-6996
Mailing Address - Fax:
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2100
Practice Address - Fax:406-488-2261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8205208600000X
OH34007687208600000X
AK6547208600000X
WV2389208600000X
MT80833208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001592Medicaid
AKMD0693Medicaid
OH2471954Medicaid
OH4130081Medicare PIN
OHI04345Medicare UPIN