Provider Demographics
NPI:1922115492
Name:HARRIS, MATTHEW EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EARL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-399-5550
Mailing Address - Fax:904-346-4334
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:BLDG 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-399-5550
Practice Address - Fax:904-346-4334
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1192042085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology