Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 9865 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 9855 | TN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 9865 | KY |
NPI | 1558651554 |
---|---|
Provider Name | Dr. Robbie James Harris III |
First Address | Paducah, KY 42001-6722 |
Second Address | Paducah, KY 42001-6722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 17/03/2018 |