MEDICARE: DR. BOBBY E HARRISON 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	207R00000X	Internal Medicine Physician	ME87831	FL
2	2085R0001X	Radiation Oncology Physician	ME 87831	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00861454	OTHER	FL	RR MEDICARE
3	P009058928	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598756074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY E HARRISON MD

Provider Business Mailing Address
First Line	:	1942 SW LITTLE RD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-1756
Country	:	US
Telephone Number	:	386-365-4492
Fax Number	:	386-487-5075

Provider Business Practice Location Address
First Line	:	1942 SW LITTLE RD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-1756
Country	:	US
Telephone Number	:	386-365-4492
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/21/2020

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