Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA03455300 | NJ |
Y | 208600000X | Surgeon | 25MA03455300 | NJ |
NPI | 1003894023 |
---|---|
Provider Name | Dr. Ronald Keith Harris |
First Address | Tampa, FL 33622-1724 |
Second Address | Tampa, FL 33626-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 15/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1510509 | (05) | NJ |
D98913 | (02) |