Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A20819 | CA |
NPI | 1093928277 |
---|---|
Provider Name | Prof. John Bruce Harris |
First Address | Pebble Beach, CA 93953-1615 |
Second Address | Pebble Beach, CA 93953-2943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |