Basic Information
| Provider Information | |||||||||
| NPI: | 1376695452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | BEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012615 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1500 AVENUE H | ||||||||
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| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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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 | 207P00000X | 1349 | NV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.