Provider Demographics
NPI:1083607048
Name:HARRIS, ROBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
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 1:2940 SQUALICUM PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1892
Mailing Address - Country:US
Mailing Address - Phone:360-733-0640
Mailing Address - Fax:360-733-1034
Practice Address - Street 1:2940 SQUALICUM PKWY
Practice Address - Street 2:STE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1892
Practice Address - Country:US
Practice Address - Phone:360-733-0640
Practice Address - Fax:360-733-1034
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016022204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8104002Medicaid
WAA09527Medicare UPIN