Provider Demographics
NPI:1982732087
Name:HARRIS, TOMMY RAY (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:RAY
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 1:140 N ENGLEWOOD DRIVE
Mailing Address - Street 2:PO BOX 7695
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-937-6611
Mailing Address - Fax:252-937-7388
Practice Address - Street 1:140 N ENGLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-937-6611
Practice Address - Fax:252-937-7388
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939968Medicaid
NC890135EOtherMEDICAID
NC8939968Medicaid
B79469Medicare UPIN