Provider Demographics
NPI:1265620116
Name:GREGG M HARRIS DPM PA
Entity type:Organization
Organization Name:GREGG M HARRIS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PA
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-488-3338
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N
Mailing Address - Street 2:STE 106
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1703
Mailing Address - Country:US
Mailing Address - Phone:561-488-3338
Mailing Address - Fax:561-488-1540
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:STE 106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1703
Practice Address - Country:US
Practice Address - Phone:561-488-3338
Practice Address - Fax:561-488-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0001441213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1761Medicare PIN
FL1068190001Medicare NSC
FLT55538Medicare UPIN