Jack Richard Harris, M.D.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

G1425 Issued in TX

Practice address

1128 Medical Dr
Tyler, TX 75701-2109

Phone

(903) 593-8273

Fax

(903) 595-0204

NPI assigned

Aug 25, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1467445452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603725",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603725",
            "telephone_number": "828-575-2625",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012109",
            "telephone_number": "903-593-8273",
            "fax_number": "903-595-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JACK",
        "middle_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "TX",
            "license": "G1425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467445452",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "569909ZPF",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine M Harris, LPC
• Curnifa Fredrica Harris
• Gilda Harris, PA-C
• Haley Nicole Harris, MS, LPC
• Iana G Harris, PA-C
• James Robert Harris, MD
• Jean Ann Harris, RN, FNP-BC
• Juanita C. Harris, C.O.T.
• Ryan Harris, M.D.
• Shaniecia Harris

• Allergy & Immunology Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Allergy & Immunology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.