Provider Demographics
NPI:1205262086
Name:HARRIS, RANDALL E (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:RANDALL
Other - Middle Name:E
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1841 NEIL AVE
Mailing Address - Street 2:306 CUNZ HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1351
Mailing Address - Country:US
Mailing Address - Phone:614-292-4720
Mailing Address - Fax:614-688-3533
Practice Address - Street 1:1841 NEIL AVE
Practice Address - Street 2:306 CUNZ HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1351
Practice Address - Country:US
Practice Address - Phone:614-292-4720
Practice Address - Fax:614-688-3533
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0609402083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine