Provider Demographics
NPI:1043218902
Name:HARRIS, ROY WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WILLIAM
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-1554
Mailing Address - Country:US
Mailing Address - Phone:419-562-9834
Mailing Address - Fax:419-562-9977
Practice Address - Street 1:510 HILL ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1554
Practice Address - Country:US
Practice Address - Phone:419-562-9834
Practice Address - Fax:419-562-9977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005746207R00000X
ALDO-469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0931906Medicaid
0878822Medicare PIN
OH0931906Medicaid