Provider Demographics
NPI:1932547718
Name:HARRIS, SEBASTIAN M (MD)
Entity Type:Individual
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First Name:SEBASTIAN
Middle Name:M
Last Name:HARRIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:750 BROADWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1411
Mailing Address - Country:US
Mailing Address - Phone:260-423-2682
Mailing Address - Fax:260-422-4326
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1411
Practice Address - Country:US
Practice Address - Phone:260-423-2682
Practice Address - Fax:260-422-4326
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2014-10-10
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Provider Licenses
StateLicense IDTaxonomies
IN01074347A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine