=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558535096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT B HARRIS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2008
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 PINE STREET SUITE 202
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-386-4701
-----------------------------------------------------
Fax | 334-265-0070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 PINE STREET SUITE 202
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-386-4701
-----------------------------------------------------
Fax | 334-265-0070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. ROBERT BOATWRIGHT HARRIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 334-386-4701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 00019179
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------