Healthcare Provider Details

I. General information

NPI: 1578511143
Provider Name (Legal Business Name): CHIP BENNETT HARRINGTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

5801 WESTMONT DR
AUSTIN TX
78731-3825
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF8145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: