Provider Demographics
NPI:1912110230
Name:HARRIS, MATHESON ADAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHESON
Middle Name:ADAMS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4400 S 700 E
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3053
Mailing Address - Country:US
Mailing Address - Phone:801-264-4420
Mailing Address - Fax:801-266-0604
Practice Address - Street 1:4400 S 700 E
Practice Address - Street 2:SUITE 130
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3053
Practice Address - Country:US
Practice Address - Phone:801-264-4420
Practice Address - Fax:801-266-0604
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV23582207W00000X
UT7928404-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology