Individual
MICHAEL SHANE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3330 MASONIC DR, ALEXANDRIA, LA 71301-3841
(318) 449-2415
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200360
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2353454
—
LA
Enumeration date
07/30/2010
Last updated
02/08/2017
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