Basic Information
| Provider Information | |||||||||
| NPI: | 1033173729 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAVID M HARRIS MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DAVID M HARRIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 933 | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247010933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043272976 | ||||||||
| FaxNumber: | 3043272989 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WESTWOOD MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043272976 | ||||||||
| FaxNumber: | 3043272989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAYERS | ||||||||
| AuthorizedOfficialFirstName: | NETTIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN PRACTICE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3043272907 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 13456 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0101504000 | 05 | WV | MEDICAID |