Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101012300 | MI |
N | 111NI0900X | Internist | 5101012300 | MI |
N | 207RC0200X | Critical Care Medicine | 5101012300 | MI |
Y | 207RP1001X | Pulmonary Disease | 5101012300 | MI |
NPI | 1033144266 |
---|---|
Provider Name | Paul D Harris |
First Address | Grand Rapids, MI 49503-4328 |
Second Address | Grand Rapids, MI 49503-4693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 14/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4306439 | (05) | MI |
4877939 | (05) | MI |
H35627 | (02) | MI |