Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036154470 | IL |
N | 207X00000X | Orthopaedic Surgeon | MD.39351 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036154470 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD.39351 | AL |
NPI | 1083092167 |
---|---|
Provider Name | Dr. Wallace Taylor Harris |
First Address | Birmingham, AL 35205-1638 |
Second Address | Birmingham, AL 35205-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 03/11/2021 |