Healthcare Provider Details

I. General information

NPI: 1609505858
Provider Name (Legal Business Name): MR. WILLIAM EUGENE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2022
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

7 AZALEA CT
LULING LA
70070-3216
US

V. Phone/Fax

Practice location:
  • Phone: 504-220-6115
  • Fax:
Mailing address:
  • Phone: 504-220-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: