Provider Demographics
NPI:1891772802
Name:HARRIS, WILLIAM MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DUTCH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLENDENIN
Mailing Address - State:WV
Mailing Address - Zip Code:25045-9528
Mailing Address - Country:US
Mailing Address - Phone:304-968-3033
Mailing Address - Fax:304-968-3103
Practice Address - Street 1:11950 MACCORKLE AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:WV
Practice Address - Zip Code:25315-1135
Practice Address - Country:US
Practice Address - Phone:304-220-2111
Practice Address - Fax:304-220-2183
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1320207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001316637OtherWV BCBS
WVP00030193OtherCH1 RAILROAD MEDICARE
WV1056879OtherWV DWC
WV5530031OtherAETNA
WVP00059183OtherCH2 RAILROAD MEDICARE
WV0077610000Medicaid
WV0077610000Medicaid
WVP00030193OtherCH1 RAILROAD MEDICARE
WVHA0797825Medicare ID - Type UnspecifiedCH2 MEDICARE