Healthcare Provider Details

I. General information

NPI: 1184003063
Provider Name (Legal Business Name): MR. DARRYL PREVOST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROYAL JUDAH CONSTRUCTION

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 SWIFT BROOK GLEN WAY
SPRING TX
77389-2995
US

IV. Provider business mailing address

5601 WIPPRECHT ST
HOUSTON TX
77026-1743
US

V. Phone/Fax

Practice location:
  • Phone: 832-798-1655
  • Fax: 281-213-0656
Mailing address:
  • Phone: 832-798-1655
  • Fax: 281-213-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: