Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 27344 | TN |
Y | 207R00000X | Internist | MD13956 | AL |
Y | 111NI0900X | Internist | MD13956 | AL |
NPI | 1184698516 |
---|---|
Provider Name | Kenneth Wayne Harris |
First Address | Montrose, CO 81401-4273 |
Second Address | Montrose, CO 81401-4273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3096568 | (05) | TN |
C73442 | (02) |