Provider Demographics
NPI:1407214059
Name:HARRE, JOHN C JR (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HARRE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 TIERRA PAOLA
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938
Mailing Address - Country:US
Mailing Address - Phone:915-474-9779
Mailing Address - Fax:
Practice Address - Street 1:4620 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4708
Practice Address - Country:US
Practice Address - Phone:915-222-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator