Healthcare Provider Details

I. General information

NPI: 1811945801
Provider Name (Legal Business Name): RICHARD S HARRIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MIRABEAU ST
GREENFIELD OH
45123-1617
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 937-981-2116
  • Fax: 937-981-9238
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34004098H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: