Healthcare Provider Details

I. General information

NPI: 1336223593
Provider Name (Legal Business Name): RICHARD SATIANTY HARRIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 9 WEST CARNEGIE INDIAN HEALTH CLINIC
CARNEGIE OK
73015
US

IV. Provider business mailing address

PO BOX 338
MOUNTAIN VIEW OK
73062-0338
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1100
  • Fax:
Mailing address:
  • Phone: 405-249-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4310
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: