Provider Demographics
NPI:1184003063
Name:PREVOST, DARRYL
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:PREVOST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROYAL
Other - Middle Name:JUDAH
Other - Last Name:CONSTRUCTION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5601 WIPPRECHT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-1743
Mailing Address - Country:US
Mailing Address - Phone:832-798-1655
Mailing Address - Fax:281-213-0656
Practice Address - Street 1:3023 SWIFT BROOK GLEN WAY
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-2995
Practice Address - Country:US
Practice Address - Phone:832-798-1655
Practice Address - Fax:281-213-0656
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor