Provider Demographics
NPI:1215033501
Name:HARRIS, RONALD M (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
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:PO BOX 4716-355
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:44210-4716
Mailing Address - Country:US
Mailing Address - Phone:512-837-1984
Mailing Address - Fax:
Practice Address - Street 1:2319 N MOPAC EXPY
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2486
Practice Address - Country:US
Practice Address - Phone:512-837-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3184291205207ND0900X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ723503Medicaid
MT0048438Medicaid
NV002085554Medicaid
UT870468377001Medicaid
ID004136100Medicaid
UT870468377001Medicaid