Provider Demographics
NPI:1184783979
Name:HARRIS, WILLIAM M I (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:HARRIS
Suffix:I
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 EL PASO AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-5824
Mailing Address - Country:US
Mailing Address - Phone:325-573-7834
Mailing Address - Fax:325-573-0322
Practice Address - Street 1:4604 EL PASO
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6162
Practice Address - Country:US
Practice Address - Phone:325-573-7834
Practice Address - Fax:325-573-0322
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225675367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX225675OtherTEXAS LICENSE RN #