Provider Demographics
NPI:1558535096
Name:ROBERT B HARRIS MD PC
Entity Type:Organization
Organization Name:ROBERT B HARRIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BOATWRIGHT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-386-4701
Mailing Address - Street 1:1801 PINE STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1154
Mailing Address - Country:US
Mailing Address - Phone:334-386-4701
Mailing Address - Fax:334-265-0070
Practice Address - Street 1:1801 PINE STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1154
Practice Address - Country:US
Practice Address - Phone:334-386-4701
Practice Address - Fax:334-265-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
AL00019179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102182Medicaid
AL102182Medicaid