Provider Demographics
NPI:1104829084
Name:BLOCK, HAROLD MORRIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:MORRIS
Last Name:BLOCK
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 1:2126 MONTANA AVE.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903
Mailing Address - Country:US
Mailing Address - Phone:915-838-8484
Mailing Address - Fax:915-351-2203
Practice Address - Street 1:2126 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903
Practice Address - Country:US
Practice Address - Phone:915-838-8484
Practice Address - Fax:915-351-2203
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0802208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127094401Medicaid
TX127094405Medicaid
TX00AH05Medicare ID - Type UnspecifiedSOLO MEDICARE ID
TX127094405Medicaid