Provider Demographics
NPI:1720202583
Name:RICHARD G. HARRIS, MD, LTD
Entity Type:Organization
Organization Name:RICHARD G. HARRIS, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-352-3535
Mailing Address - Street 1:PO BOX 50880
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-0880
Mailing Address - Country:US
Mailing Address - Phone:775-352-3535
Mailing Address - Fax:775-352-3530
Practice Address - Street 1:2385 E PRATER WAY
Practice Address - Street 2:SUITE #104
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9629
Practice Address - Country:US
Practice Address - Phone:775-352-3535
Practice Address - Fax:775-352-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7275207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV050063835OtherRAILROAD MEDICARE
NV002016718Medicaid
NV30005Medicare ID - Type UnspecifiedFEE FOR SERVICE MEDICARE