Provider Demographics
NPI:1780692533
Name:HARRIS, ROY MC (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:MC
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 SUNSET BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3093
Mailing Address - Country:US
Mailing Address - Phone:916-624-0300
Mailing Address - Fax:916-624-0631
Practice Address - Street 1:3104 SUNSET BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3093
Practice Address - Country:US
Practice Address - Phone:916-624-0300
Practice Address - Fax:916-624-0631
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG63972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G639720Medicaid
CA00G639720Medicaid
B42861Medicare UPIN