Individual
JUAN-DIEGO HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 LYON PL, OGDENSBURG, NY 13669-2590
(315) 394-7542
(315) 394-0015
Mailing address
3 LYON PL, OGDENSBURG, NY 13669-2590
(315) 394-7542
(315) 394-0015
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
X001531-1
NY
208VP0014X
Interventional Pain Medicine Physician
Primary
001531
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02375226
—
NY
01
—
RB6019
PTAN
NY
Enumeration date
11/11/2005
Last updated
12/12/2019
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