# MUTINY BAY MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427378355
- **Authorized official:** THOMAS HARRIS DO (PHYSICIAN)
- **Authorized official phone:** (360) 331-3391

## Contact information

- **Practice address:** 5548 MYRTLE AVE STE 201, FREELAND, WA 98249-8776
- **Practice address phone:** (360) 331-3391
- **Mailing address:** 5548 MYRTLE AVE STE 201, FREELAND, WA 98249-8776
- **Mailing address phone:** (360) 331-3391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OP00001446 | WA | Yes |

## Other

- **Enumeration date:** 06/02/2010
- **Last updated:** 06/02/2010