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1558479410

NPI Code Detail

MEDICARE: WILLIAM BLAKE HAREN MD

MEDICARE: WILLIAM BLAKE HAREN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	P9869	TX
2	207R00000X	Internal Medicine Physician	P9869	TX
3	207R00000X	Internal Medicine Physician	20889	SC
4	2084P0800X	Psychiatry Physician	20889	SC
5	2084P0800X	Psychiatry Physician	36463	TN

General Provider Information

NPI Number	:	1558479410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BLAKE HAREN MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST STE 2509
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2777
Country	:	US
Telephone Number	:	326-238-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2509
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2777
Country	:	US
Telephone Number	:	326-238-2040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/20/2023

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Directions to “ WILLIAM BLAKE HAREN MD” Practice Location

Language	Start Address	Practice Location

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