Provider Demographics
NPI:1891732582
Name:HARRIS, CLARISSA OLIVEIRA (MD)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:OLIVEIRA
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 1:2700 NE 14TH STREET CSWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3561
Mailing Address - Country:US
Mailing Address - Phone:954-942-8177
Mailing Address - Fax:954-942-1819
Practice Address - Street 1:2700 NE 14TH STREET CSWY
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3561
Practice Address - Country:US
Practice Address - Phone:954-942-8177
Practice Address - Fax:954-942-1819
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME88074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFLME88074OtherMEDICAL LICENSE NUMBER
FLU12282Medicare ID - Type Unspecified
FLFLME88074OtherMEDICAL LICENSE NUMBER