Healthcare Provider Details

I. General information

NPI: 1346244209
Provider Name (Legal Business Name): RICHARD M HARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 BERT KOUNS INDUSTRIAL LOOP STE 200
SHREVEPORT LA
71118-3166
US

IV. Provider business mailing address

2508 BERT KOUNS INDUSTRIAL LOOP STE 200
SHREVEPORT LA
71118-3166
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5044
  • Fax: 318-212-5049
Mailing address:
  • Phone: 318-212-5044
  • Fax: 318-212-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number019429
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: