Provider Demographics
NPI:1528209160
Name:HARRIS, WILLIAM JOSEPH JR (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 REGULUS AVE
Mailing Address - Street 2:NSWDG (N00M)
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461
Mailing Address - Country:US
Mailing Address - Phone:757-893-2026
Mailing Address - Fax:757-492-8409
Practice Address - Street 1:1636 REGULUS AVE
Practice Address - Street 2:NSWDG (N00M)
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461
Practice Address - Country:US
Practice Address - Phone:757-893-2026
Practice Address - Fax:757-492-8409
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman