Organization
TIDAL EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL H. HARRIS, MD (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
1945 CORLIES AVE, NEPTUNE, NJ 07753-4859
(732) 776-4203
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7660103
—
NJ
Enumeration date
05/17/2006
Last updated
12/24/2013
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