Active NPI
Robert Ronnie Harrell, M.D.
- Cardiovascular Disease Physician
- Dothan, AL
National Provider Identifier
1083608871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 5934
- Practice address
- 4300 W Main St
Suite 102
Dothan, AL 36305-1054 - Phone
- (334) 793-9564
- Fax
- (334) 671-8907
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 5934 | AL | Primary |
Addresses
Primary practice location
4300 W Main St
Suite 102
Dothan, AL 36305-1054
Mailing address
4300 W Main St
Suite 102
Dothan, AL 36305-1054
Phone (334) 793-9564
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00110503A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5934 | AL | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196899200000",
"number": "1083608871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 W MAIN ST",
"address_2": "SUITE 102",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363051054",
"telephone_number": "334-793-9564",
"fax_number": "334-671-8907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 W MAIN ST",
"address_2": "SUITE 102",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363051054",
"telephone_number": "334-793-9564",
"fax_number": "334-671-8907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRELL",
"first_name": "ROBERT",
"middle_name": "RONNIE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2007-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "AL",
"license": "5934",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00110503A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.