Provider Demographics
NPI:1811991607
Name:HARRIS, HOADLEY HOWE (MD)
Entity type:Individual
Prefix:DR
First Name:HOADLEY
Middle Name:HOWE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5917
Mailing Address - Country:US
Mailing Address - Phone:701-499-4800
Mailing Address - Fax:701-451-9452
Practice Address - Street 1:3290 20TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5917
Practice Address - Country:US
Practice Address - Phone:701-499-4807
Practice Address - Fax:701-451-9452
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5224207Q00000X
MN29469207Q00000X
AZ20110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHAR23165OtherND BLUE SHIELD
MN068K6HAOtherMN BLUE SHIELD
ND16642Medicaid
MN796768300Medicaid
ND23165Medicare PIN
NDHAR23165OtherND BLUE SHIELD