Provider Demographics
NPI: | 1245414317 |
---|---|
Name: | BOSTON, CATHERINE WELLS HARRIS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CATHERINE |
Middle Name: | WELLS HARRIS |
Last Name: | BOSTON |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | CATHERINE |
Other - Middle Name: | WELLS |
Other - Last Name: | HARRIS |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 3533 S ALAMEDA ST |
Mailing Address - Street 2: | |
Mailing Address - City: | CORPUS CHRISTI |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78411-1721 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 361-694-5311 |
Mailing Address - Fax: | 361-808-2069 |
Practice Address - Street 1: | 3533 S ALAMEDA ST |
Practice Address - Street 2: | |
Practice Address - City: | CORPUS CHRISTI |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78411 |
Practice Address - Country: | US |
Practice Address - Phone: | 361-694-5311 |
Practice Address - Fax: | 361-808-2069 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-12-24 |
Last Update Date: | 2020-12-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N7227 | 208000000X, 2080P0207X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 282326202 | Medicaid |