Individual
DR. JERRY L. HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Mailing address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME22775
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0370282
—
FL
01
—
221572315
RAILROAD MEDICARE
FL
01
—
37210
BCBS INDIVIDUAL PROVIDER#
FL
01
—
ME22775
FL MEDICAL EXAMINER LICEN
FL
Enumeration date
01/25/2006
Last updated
01/17/2008
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