Provider Demographics
NPI:1700093606
Name:HARRIS, LAURIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-0887
Mailing Address - Country:US
Mailing Address - Phone:972-427-3951
Mailing Address - Fax:972-427-3684
Practice Address - Street 1:1017 W.HWY 175
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114
Practice Address - Country:US
Practice Address - Phone:972-427-3951
Practice Address - Fax:972-427-3684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice