Provider Demographics
NPI:1255393187
Name:HARRIS, STEVEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
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 1:102 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2911
Mailing Address - Country:US
Mailing Address - Phone:334-793-4788
Mailing Address - Fax:334-793-1561
Practice Address - Street 1:102 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2911
Practice Address - Country:US
Practice Address - Phone:334-793-4788
Practice Address - Fax:334-793-1561
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051031971OtherBCBS PROVIDER NUMBER
AL0000319791Medicaid
AL040011243OtherRAILROAD MEDICARE
AL174014500OtherUS DEPT OF LABOR
ALE20785Medicare UPIN
AL051031971OtherBCBS PROVIDER NUMBER