Individual
JEFFREY L HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 408-8014
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01041577A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100362700
—
IN
01
—
200034548
RAIL ROAD MEDICARE
IN
05
—
2147402
—
OH
Enumeration date
07/15/2005
Last updated
10/30/2018
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