Provider Demographics
NPI:1508526187
Name:ROBERT LEE HARRELL MD PC
Entity Type:Organization
Organization Name:ROBERT LEE HARRELL MD PC
Other - Org Name:RH FACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-358-4282
Mailing Address - Street 1:2211 WIDENER TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6427
Mailing Address - Country:US
Mailing Address - Phone:561-358-4282
Mailing Address - Fax:
Practice Address - Street 1:2211 WIDENER TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6427
Practice Address - Country:US
Practice Address - Phone:561-358-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME134217OtherLICENSE