Provider Demographics
NPI:1912420845
Name:HARRIS, JOHN ALTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALTON
Last Name:HARRIS
Suffix:III
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 1:3106 OLD POND RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3255
Mailing Address - Country:US
Mailing Address - Phone:406-728-6615
Mailing Address - Fax:
Practice Address - Street 1:3106 OLD POND RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3255
Practice Address - Country:US
Practice Address - Phone:406-728-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-3760207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology