Provider Demographics
NPI:1992178164
Name:HARRIS, ROBERT (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 YELLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5234
Mailing Address - Country:US
Mailing Address - Phone:435-740-0860
Mailing Address - Fax:
Practice Address - Street 1:108 YELLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5234
Practice Address - Country:US
Practice Address - Phone:435-740-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY193237700000X
UT9171940-4602237700000X
IDHA-2805237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist