Basic Information
| Provider Information | |||||||||
| NPI: | 1225025182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2160 COLONIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317212 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 2141 LOCH RANE BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044271270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME0065014 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1108014 | 01 | FL | CARE PLUS HEALTH PLANS | OTHER | 252340000 | 05 | FL | MEDICAID | 225221 | 01 | FL | AVMED | OTHER | P01327656 | 01 | FL | RR MEDICARE | OTHER | 684702 | 01 | FL | WELLCARE | OTHER | P982978 | 01 | FL | FREEDOM HEALTH | OTHER | 1193110 | 01 | FL | WELLCARE | OTHER | 41406 | 01 | FL | BC BS | OTHER | P0026504 | 01 | FL | FLORIDA HEALTHCARE PLUS | OTHER | P01593276 | 01 | FL | RR MEDICARE | OTHER | 5385643 | 01 | FL | AETNA | OTHER |