Provider Demographics
NPI:1922068238
Name:HARRIS, JOHN G JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 W MONROE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1177
Mailing Address - Country:US
Mailing Address - Phone:904-355-1553
Mailing Address - Fax:904-356-7774
Practice Address - Street 1:915 W MONROE ST STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1177
Practice Address - Country:US
Practice Address - Phone:904-355-1553
Practice Address - Fax:904-356-7774
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3181213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA580964184AMedicaid
FL3405826-00Medicaid
FLV09982Medicare UPIN
FL3405826-00Medicaid
GA580964184AMedicaid
FL5711450001Medicare NSC