Provider Demographics
NPI:1750606802
Name:HARRIS, TOMMIE T (DPM)
Entity type:Individual
Prefix:DR
First Name:TOMMIE
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 LONG PRAIRIE RD STE 550
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:214-285-0010
Mailing Address - Fax:214-285-0026
Practice Address - Street 1:4491 LONG PRAIRIE RD STE 550
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1795
Practice Address - Country:US
Practice Address - Phone:214-285-0010
Practice Address - Fax:214-285-0026
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT28-2009213ES0103X
TX45D2274201291U00000X
TX1947213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105287OtherMEDICARE PTAN
TX213917201Medicaid
TXTXB128789OtherMEDICARE PTAN