Provider Demographics
NPI:1356316368
Name:HARRIS, BENJAMIN K. HARRIS KEITH (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN K. HARRIS
Middle Name:KEITH
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 1:512 E STELLA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1172
Mailing Address - Country:US
Mailing Address - Phone:602-263-9294
Mailing Address - Fax:
Practice Address - Street 1:926 E MCDOWELL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2503
Practice Address - Country:US
Practice Address - Phone:602-253-9223
Practice Address - Fax:602-253-9790
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5818207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD5818Medicare ID - Type Unspecified
AZD36987Medicare UPIN