Provider Demographics
NPI:1831110402
Name:HARRELL, ROBERT L III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HARRELL
Suffix:III
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 1:2211 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:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1342172086S0102X, 208M00000X, 208G00000X
NH13334208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206170Medicaid
ME432337699Medicaid
ME432337699Medicaid
NH30206170Medicaid