Organization
CALEB H HARRIS MD FACS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALEB HARRIS (PRESIDENT)
(580) 762-6676
Entity
Organization
Contact information
Practice address
121 PATTON DR, PONCA CITY, OK 74601-2030
(580) 762-6676
Mailing address
121 PATTON DR, PONCA CITY, OK 74601-2030
(580) 762-6676
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23713
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100144020B
—
OK
01
—
452193157-001
BLUE CROSS BLUE SHIELD OF OKLAHOMA
OK
Enumeration date
03/25/2008
Last updated
04/22/2008
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