Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME47899 | FL |
NPI | 1205126992 |
---|---|
Provider Name | Dr. Walter David Harris |
First Address | Destin, FL 32541-5331 |
Second Address | Destin, FL 32541-5331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 14/04/2011 |