Provider Demographics
NPI:1982644415
Name:HARRIS, DARRYL C SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:C
Last Name:HARRIS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6230 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1251
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5126
Mailing Address - Country:US
Mailing Address - Phone:323-549-3420
Mailing Address - Fax:323-375-1341
Practice Address - Street 1:2126 S LA BREA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2277
Practice Address - Country:US
Practice Address - Phone:323-549-3420
Practice Address - Fax:323-375-1341
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG88191208VP0000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine