Individual
DR. SCOTT SIDNEY HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N BROADWAY, PELICAN RAPIDS, MN 56572-4113
(218) 863-2000
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 863-2000
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5107
ND
208D00000X
General Practice Physician
Primary
28934
MN
208D00000X
General Practice Physician
5107
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14688
—
ND
01
—
15107
MEDICAID
ND
05
—
15107
—
ND
05
—
1740402858
—
MN
01
—
CF8850
RAILROAD MEDICARE
ND
01
—
P00806459
RAILROAD MEDICARE
ND
Enumeration date
05/02/2007
Last updated
11/12/2012
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