Provider Demographics
NPI:1831149210
Name:HARRIS, DANIEL CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHRISTOPHER
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 1:2410 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1356
Mailing Address - Country:US
Mailing Address - Phone:580-226-0812
Mailing Address - Fax:580-226-0820
Practice Address - Street 1:2410 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1356
Practice Address - Country:US
Practice Address - Phone:580-226-0812
Practice Address - Fax:580-226-0820
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200044120AMedicaid
OK23380OtherOKLAHOMA LICENSE
OK23380OtherOKLAHOMA LICENSE
OK500522099Medicare PIN