Provider Demographics
NPI:1174600100
Name:HARRIS, LEROY F (MD)
Entity type:Individual
Prefix:MS
First Name:LEROY
Middle Name:F
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 1:1112 WESTMORELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-2754
Mailing Address - Country:US
Mailing Address - Phone:256-533-4640
Mailing Address - Fax:256-533-4647
Practice Address - Street 1:101A BOB WALLACE AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3843
Practice Address - Country:US
Practice Address - Phone:256-533-4640
Practice Address - Fax:256-433-4647
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8559207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000005760HARMedicaid
AL0000005760HARMedicaid
AL051005760HARMedicare PIN