Provider Demographics
NPI:1275539074
Name:HARRIS, JOSEPH DENTON IV (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DENTON
Last Name:HARRIS
Suffix:IV
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 1:755 N 11TH ST
Mailing Address - Street 2:STE P-3200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-899-4111
Mailing Address - Fax:409-899-5670
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE P-3200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-899-4111
Practice Address - Fax:409-899-5670
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127882201Medicaid
TX127882201Medicaid
TXHA08309J1Medicare ID - Type UnspecifiedMEDICARE NUMBER