Basic Information
| Provider Information | |||||||||
| NPI: | 1104980598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DARRYL C. HARRIS , MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 HOSPITAL DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092121000 | ||||||||
| FaxNumber: | 4092121003 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 HOSPITAL DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092121000 | ||||||||
| FaxNumber: | 4092121003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
| AuthorizedOfficialMiddleName: | DARLENE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4092121000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | L3676 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1627771 | 05 | LA | MEDICAID | 0029HL | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |