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Individual

STEVEN WAYNE HARRIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
3917 WEST ROAD #250, LOS ALAMOS, NM 87544-5302
(505) 661-4147
(505) 661-4199
Mailing address
1620 N MAIN ST, SPANISH FORK, UT 84660-1008
(801) 822-2234

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
53426961206
UT
363AM0700X
Medical Physician Assistant
Primary
PA2011-0036
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
870281028000
UT
01
P00084336
PALMETTO GBA
UT
Enumeration date
05/03/2006
Last updated
07/14/2020
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