Healthcare Provider Details

I. General information

NPI: 1144369752
Provider Name (Legal Business Name): ROBERT ALAN HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT A. HARRIS M.D.

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 N ROBINS DR STE B101
LAYTON UT
84041-7058
US

IV. Provider business mailing address

5150 S 375 E STE 3
WASHINGTON TERRACE UT
84405-4503
US

V. Phone/Fax

Practice location:
  • Phone: 801-807-7777
  • Fax: 801-807-7778
Mailing address:
  • Phone: 801-475-6532
  • Fax: 801-475-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number5552158-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5552158-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: