Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 012876 | NY |
NPI | 1154531036 |
---|---|
Provider Name | Mr. Mark Garry Harris |
First Address | Olean, NY 14760-1115 |
Second Address | Olean, NY 14760-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |