Provider Demographics
NPI:1538472956
Name:HARRIS, BOBBY JUNE (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JUNE
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:PO BOX 191493
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-9493
Mailing Address - Country:US
Mailing Address - Phone:213-736-7605
Mailing Address - Fax:800-539-3299
Practice Address - Street 1:3435 WILSHIRE BLVD
Practice Address - Street 2:CALIFORNIA DEPARTMENT OF SOCIAL SERVICES SUITE 1400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1915
Practice Address - Country:US
Practice Address - Phone:213-736-7605
Practice Address - Fax:800-539-3299
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31791208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery