Healthcare Provider Details

I. General information

NPI: 1205944196
Provider Name (Legal Business Name): GLENNA G HARRIS M.D., FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LONDONDERRY LN
DENTON TX
76205-5337
US

IV. Provider business mailing address

515 LONDONDERRY LN
DENTON TX
76205-5337
US

V. Phone/Fax

Practice location:
  • Phone: 940-484-0065
  • Fax: 940-484-2205
Mailing address:
  • Phone: 940-484-0065
  • Fax: 940-484-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF1626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: