Individual
DR. CAMILLE ELIZABETH HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1105 E USTICK RD, CALDWELL, ID 83605
(208) 463-7732
(541) 889-4736
Mailing address
1105 E USTICK RD, CALDWELL, ID 83605-6306
(208) 402-6587
(208) 402-6578
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00359
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023111
—
OR
01
—
4540570001
MEDICARE DMERC
OR
05
—
807150700
—
ID
01
—
861141948
TAX ID
OR
01
—
P00251554
RAILROAD MEDICARE
ID
01
—
P00251554
RAILROAD MEDICARE
OR
Enumeration date
06/20/2005
Last updated
07/17/2018
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