Provider Demographics
NPI:1013187681
Name:HARRISON, RICHARD JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:HARRISON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:709 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1938
Mailing Address - Country:US
Mailing Address - Phone:321-725-2225
Mailing Address - Fax:321-308-0635
Practice Address - Street 1:709 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1938
Practice Address - Country:US
Practice Address - Phone:321-725-2225
Practice Address - Fax:321-308-0635
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241712207X00000X, 207XS0106X
FLME110018207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1483327OtherCIGNA
FL14H4NOtherFLORIDA BLUE
FL007050300OtherMEDICAID NON FFS
FL2300218OtherCOVENTRY
FLP01256129OtherRAILROAD MEDICARE
FL901776OtherAETNA
FL1483327OtherCIGNA
FL14H4NOtherFLORIDA BLUE