Provider Demographics
NPI:1750572525
Name:ROBERT C. HARRIS, M.D.
Entity type:Organization
Organization Name:ROBERT C. HARRIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-759-4098
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 181W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-759-4098
Mailing Address - Fax:270-767-3627
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 181W
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-759-4098
Practice Address - Fax:270-767-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64205941Medicaid
000000048048OtherANTHEM BC/BS
KY64205941Medicaid
KY3715Medicare PIN