Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101023906 | VA |
NPI | 1003820523 |
---|---|
Provider Name | Dr. David Lea Harris |
First Address | Kilmarnock, VA 22482-1449 |
Second Address | Kilmarnock, VA 22482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7572611 | (05) | VA |
B08064 | (02) |