Provider Demographics
NPI:1306263710
Name:HARRIS, DWAYNE
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W ALABAMA ST
Mailing Address - Street 2:STE. 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5161
Mailing Address - Country:US
Mailing Address - Phone:713-529-1402
Mailing Address - Fax:713-529-1404
Practice Address - Street 1:315 W ALABAMA ST
Practice Address - Street 2:STE. 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5161
Practice Address - Country:US
Practice Address - Phone:713-529-1402
Practice Address - Fax:713-529-1404
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based