Provider Demographics
NPI:1225301435
Name:HARRIS, JOSEPH EUGENE JR
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4565
Mailing Address - Country:US
Mailing Address - Phone:216-252-2728
Mailing Address - Fax:
Practice Address - Street 1:12300 WAYLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4565
Practice Address - Country:US
Practice Address - Phone:216-385-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123401 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse