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General NPI Number Information
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NPI Number | 1023300936
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Entity Type | Individual
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Provider Name | RICHARD BOOTH HARRIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1850 BLUEGRASS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40215
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Country | US
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Telephone | 502-361-6617
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Fax | 502-361-6637
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST STE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1428
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Country | US
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Telephone | 502-361-6617
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Fax | 502-361-6637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 04047
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 006642
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License Number State | AZ
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