Healthcare Provider Details

I. General information

NPI: 1548219231
Provider Name (Legal Business Name): ROBERT BRIAN HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SECOND ST.
BERNICE LA
71222
US

IV. Provider business mailing address

205 SHENANDOAH DR
DUBACH LA
71235-3279
US

V. Phone/Fax

Practice location:
  • Phone: 318-285-9066
  • Fax: 318-285-9065
Mailing address:
  • Phone: 318-255-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL023103
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: