Provider Demographics
NPI:1144461591
Name:SALIM, HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:
Last Name:SALIM
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 1:3636 STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0514
Mailing Address - Country:US
Mailing Address - Phone:928-757-3680
Mailing Address - Fax:928-757-3614
Practice Address - Street 1:3636 STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0514
Practice Address - Country:US
Practice Address - Phone:928-757-3680
Practice Address - Fax:928-757-3614
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ643802Medicaid
AZ643802Medicaid