Provider Demographics
NPI:1346486883
Name:HARWELL, PHILLIP (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:HARWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-3554
Mailing Address - Country:US
Mailing Address - Phone:409-960-6979
Mailing Address - Fax:
Practice Address - Street 1:3946 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-3554
Practice Address - Country:US
Practice Address - Phone:409-960-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ48482083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine