Provider Demographics
NPI:1780817205
Name:SOUTH, HARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:L
Last Name:SOUTH
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 1:2800 E BROAD ST STE 318
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6413
Mailing Address - Country:US
Mailing Address - Phone:817-779-3178
Mailing Address - Fax:844-292-1460
Practice Address - Street 1:2800 E BROAD ST STE 318
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6413
Practice Address - Country:US
Practice Address - Phone:817-779-3178
Practice Address - Fax:844-292-1460
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU4023207RC0000X
NJ25MA09617800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3052898OtherTAX ID#