Provider Demographics
NPI:1548219231
Name:HARRIS, ROBERT BRIAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:DUBACH
Mailing Address - State:LA
Mailing Address - Zip Code:71235-3279
Mailing Address - Country:US
Mailing Address - Phone:318-255-7688
Mailing Address - Fax:
Practice Address - Street 1:402 SECOND ST.
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222
Practice Address - Country:US
Practice Address - Phone:318-285-9066
Practice Address - Fax:318-285-9065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL023103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494496Medicaid
LA5Y591Medicare ID - Type Unspecified
LA1494496Medicaid