Provider Demographics
NPI:1801889803
Name:HARRIS, PAUL E JR (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1711
Mailing Address - Country:US
Mailing Address - Phone:614-878-6455
Mailing Address - Fax:614-878-6466
Practice Address - Street 1:15 NORTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1711
Practice Address - Country:US
Practice Address - Phone:614-878-6455
Practice Address - Fax:614-878-6466
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428577Medicaid
OHHA0477231Medicare ID - Type Unspecified
OH0428577Medicaid