Individual
CARSON R HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8040 OLD CEDAR AVE S STE 100, BLOOMINGTON, MN 55425-1205
(651) 254-3456
(651) 254-5216
Mailing address
8100 34TH AVE S, MC21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7172
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
31091
MN
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
31091
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53585100
—
MN
Enumeration date
02/17/2006
Last updated
06/11/2019
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