Individual
DR. MICHAEL THOMAS HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Mailing address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6846
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG0410
RAILROAD MEDICARE
—
Enumeration date
02/12/2008
Last updated
02/12/2008
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