Healthcare Provider Details

I. General information

NPI: 1619963667
Provider Name (Legal Business Name): GREGORY HAYS HARRIS C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 JUDSON RD
LONGVIEW TX
75601-5113
US

IV. Provider business mailing address

P.O. BOX 2527
LONGVIEW TX
75606-2527
US

V. Phone/Fax

Practice location:
  • Phone: 903-655-1313
  • Fax: 903-657-6067
Mailing address:
  • Phone: 903-655-1313
  • Fax: 903-657-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01278
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number038631
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number243531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: