Provider Demographics
NPI:1396784989
Name:HARRIS, THOMAS ALCOTT (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALCOTT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8167 S HIGH RD
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9678
Mailing Address - Country:US
Mailing Address - Phone:520-456-7263
Mailing Address - Fax:
Practice Address - Street 1:8167 S HIGH RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-9678
Practice Address - Country:US
Practice Address - Phone:520-456-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ398348Medicaid
272556OtherHEALTHNET
102427Medicare ID - Type Unspecified
AZZ102427Medicare PIN
272556OtherHEALTHNET
AZS37877Medicare UPIN