Provider Demographics
NPI:1013187681
Name:HARRISON, RICHARD JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:HARRISON
Suffix:JR
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 1:240 N WICKHAM RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8663
Mailing Address - Country:US
Mailing Address - Phone:321-541-1777
Mailing Address - Fax:321-541-1786
Practice Address - Street 1:240 N WICKHAM RD STE 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8663
Practice Address - Country:US
Practice Address - Phone:321-541-1777
Practice Address - Fax:321-541-1786
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241712207X00000X, 207XS0106X
FLME110018207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2300218OtherCOVENTRY
FL901776OtherAETNA
FL007050300OtherMEDICAID NON FFS
FLP01256129OtherRAILROAD MEDICARE
FL1483327OtherCIGNA
FL14H4NOtherFLORIDA BLUE
FL1483327OtherCIGNA
FL14H4NOtherFLORIDA BLUE