Provider Demographics
NPI:1811958416
Name:HARRIS, JUSTIN D (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:D
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 1:575 S 70TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-488-3322
Mailing Address - Fax:402-488-1172
Practice Address - Street 1:575 S. 70TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-488-3322
Practice Address - Fax:402-488-1172
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24527207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101086076Medicaid
NE470703099OtherUNITED HEALTHCARE
NE00902OtherBCBS
NE47070309913Medicaid
PA083541Medicare ID - Type Unspecified
NE47070309913Medicaid
NE093416002Medicare PIN