Provider Demographics
NPI:1700146537
Name:HARRIS, JANE SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:SUZANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:SUZANNE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2671
Mailing Address - Fax:612-904-4284
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2671
Practice Address - Fax:612-904-4284
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics