Individual
DR. BOBBY E HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1942 SW LITTLE RD, LAKE CITY, FL 32024-1756
(386) 365-4492
Mailing address
1942 SW LITTLE RD, LAKE CITY, FL 32024-1756
(386) 365-4492
(386) 487-5075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME87831
FL
2085R0001X
Radiation Oncology Physician
Primary
ME 87831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274266700
—
FL
01
—
P00861454
RR MEDICARE
FL
01
—
P009058928
RR MEDICARE
FL
Enumeration date
11/02/2005
Last updated
02/21/2020
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