Provider Demographics
NPI:1104924109
Name:HARRIES, DAVID PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:HARRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 S WASHINGTON ST # 13
Mailing Address - Street 2:PAIN MANAGEMENT CLINIC
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7245
Mailing Address - Country:US
Mailing Address - Phone:017-805-0007
Mailing Address - Fax:
Practice Address - Street 1:ALTRU INTERVENTIONAL PAIN MANAGEMENT
Practice Address - Street 2:4440 S WASHINGTON ST
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081532A208VP0014X
KY37745208VP0014X
AK210437208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00188001OtherMEDICARE PTAN
KY64070550Medicaid
IN300022878Medicaid
ININ4081001OtherMEDICARE PTAN