Individual
CLINTON LEE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-1706
(573) 556-5728
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 556-5757
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2014015594
MO
207L00000X
Anesthesiology Physician
35473
IA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2014015594
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
35473
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0462077
—
IA
Enumeration date
08/25/2005
Last updated
08/16/2023
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