Provider Demographics
NPI:1982641189
Name:HARRIS, ROBERT LOVE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOVE
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 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-326-1501
Practice Address - Street 1:1040 RIVER OAKS SR.
Practice Address - Street 2:SUITE 103
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7696
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-948-6518
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016908207VG0400X, 208800000X
MS12843208800000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS160043435OtherRAILROAD MEDICARE
MS0120177Medicaid
MS5379212OtherAETNA
MSF20487Medicare UPIN
MS160000401Medicare ID - Type Unspecified