Basic Information
| Provider Information | |||||||||
| NPI: | 1164496808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E KINCAID ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603362178 | ||||||||
| FaxNumber: | 3603361674 | ||||||||
| Practice Location | |||||||||
| Address1: | 1019 24TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603362178 | ||||||||
| FaxNumber: | 3602998147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 66209 | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0123X | MD00042133 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YX0602X | MD00042133 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207YX0905X | MD00042133 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery | 2086S0122X | MD00042133 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086X0206X | MD00042133 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 207Y00000X | MD00042133 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.