Provider Demographics
NPI:1174697619
Name:HARRIS, DAVID ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-559-0988
Mailing Address - Fax:408-369-4263
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-559-0988
Practice Address - Fax:408-369-4263
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28356207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33603Medicare UPIN
CAZZZ31903ZMedicare ID - Type Unspecified