Provider Demographics
NPI:1467674150
Name:HARRIS, JOHN DUDLEY JR (IDCDMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DUDLEY
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:IDCDMT
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Mailing Address - Street 1:6541 HILLGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4827
Mailing Address - Country:US
Mailing Address - Phone:619-524-6668
Mailing Address - Fax:619-524-6670
Practice Address - Street 1:33000 NIXIE WAY BLDG 50
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92147-5101
Practice Address - Country:US
Practice Address - Phone:619-524-6668
Practice Address - Fax:619-524-6670
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians