MEDICARE: BOBBY JUNE HARRIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	C31791	CA

General Provider Information

NPI Number	:	1538472956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY JUNE HARRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 191493
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-9493
Country	:	US
Telephone Number	:	213-736-7605
Fax Number	:	800-539-3299

Provider Business Practice Location Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	CALIFORNIA DEPARTMENT OF SOCIAL SERVICES SUITE 1400
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1915
Country	:	US
Telephone Number	:	213-736-7605
Fax Number	:	800-539-3299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	07/15/2010

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