Provider Demographics
NPI:1295796332
Name:HARRIS, BRIAN E (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:407-831-6200
Mailing Address - Fax:407-831-1068
Practice Address - Street 1:475 OSCEOLA ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7857
Practice Address - Country:US
Practice Address - Phone:407-831-6200
Practice Address - Fax:407-831-1068
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63941208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373500100Medicaid