Provider Demographics
NPI:1760543482
Name:HAROLD, JAMES GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GREGORY
Last Name:HAROLD
Suffix:
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 1:3211 LOPEZ CT
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2503
Mailing Address - Country:US
Mailing Address - Phone:903-291-1596
Mailing Address - Fax:
Practice Address - Street 1:1300 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5567
Practice Address - Country:US
Practice Address - Phone:903-297-1852
Practice Address - Fax:903-297-8798
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH81112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5363OtherBLUE CROSS BLUE SHIELD
TX159132301Medicaid
TXP00041672OtherRAILROAD MEDICARE
TXP00041672OtherRAILROAD MEDICARE
TX8A8965Medicare PIN