Healthcare Provider Details

I. General information

NPI: 1962842732
Provider Name (Legal Business Name): SAMANTHA JO HARRIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JO SEAMAN

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALLS DR
CLEBURNE TX
76033-4007
US

IV. Provider business mailing address

6451 BRENTWOOD STAIR RD STE 200
FORT WORTH TX
76112-3200
US

V. Phone/Fax

Practice location:
  • Phone: 817-556-5548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5653
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: