Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 35828 | MN |
NPI | 1164490595 |
---|---|
Provider Name | James L. Harris |
First Address | Aitkin, MN 56431-1865 |
Second Address | Aitkin, MN 56431-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G21224 | (02) |