Provider Demographics
NPI:1780670638
Name:HARRIS, RUSSELL D (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 S UNIVERSITY AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5307
Mailing Address - Country:US
Mailing Address - Phone:501-664-4532
Mailing Address - Fax:501-663-4335
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-664-4532
Practice Address - Fax:501-663-4335
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-8325207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171973300OtherUS DEPT. OF LABOR OWCP
AR55608OtherBLUE CROSS BLUE SHIELD
AR050019624OtherRAILROAD MEDICARE
AR71033532430OtherQUAL CHOICE
AR770133101OtherARKANSAS BREASTCARE
AR14975000020OtherQUAL CHOICE (LRPM)
ARS03731OtherNOVASYS
AR050019621OtherRAILROAD MEDICARE (LRPM)
AR121599001Medicaid
AR71033532430OtherQUAL CHOICE