Individual
CHARLES F HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
982 W. BROADWAY, JACKSON, WY 83002
(307) 733-8002
(307) 733-0032
Mailing address
PO BOX 15240, JACKSON, WY 83002-5240
(307) 733-8002
(307) 733-0032
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
76
WY
363AS0400X
Surgical Physician Assistant
76
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109651600
—
WY
Enumeration date
01/29/2007
Last updated
10/26/2007
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