Healthcare Provider Details

I. General information

NPI: 1205262086
Provider Name (Legal Business Name): RANDALL E. HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDALL E. HARRIS PH.D.

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 NEIL AVE 306 CUNZ HALL
COLUMBUS OH
43210-1351
US

IV. Provider business mailing address

1841 NEIL AVE 306 CUNZ HALL
COLUMBUS OH
43210-1351
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4720
  • Fax: 614-688-3533
Mailing address:
  • Phone: 614-292-4720
  • Fax: 614-688-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number35-060940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: