Provider Demographics
NPI:1245292036
Name:HARRIS, TIMOTHY LAIRD (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LAIRD
Last Name:HARRIS
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 1:3000 N I 35
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5119
Mailing Address - Country:US
Mailing Address - Phone:940-898-7310
Mailing Address - Fax:940-898-7071
Practice Address - Street 1:3000 N I 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5119
Practice Address - Country:US
Practice Address - Phone:940-898-7310
Practice Address - Fax:940-898-7071
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00369357OtherRAILROAD MEDICARE
TX171962703OtherMEDICAID OTHER
TX171962702Medicaid
TX171962702Medicaid
G78328Medicare UPIN