Organization
MICHAEL T HARRIS MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL T HARRIS MD (OWNER/PRACTITIONER)
(208) 552-1222
Entity
Organization
Contact information
Practice address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Mailing address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
M 6846
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000013
BLUE SHEILD OF IDAHO
ID
05
—
003729200
—
ID
01
—
72793
BLUE CROSS OF IDAHO
ID
01
—
P00077360
RAILROAD MEDICARE
ID
Enumeration date
10/03/2005
Last updated
11/22/2008
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