Provider Demographics
NPI:1386062396
Name:HARRIS, MCKINLEY JR
Entity type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:
Last Name:HARRIS
Suffix:JR
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 1:4315 CEDAR RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3115
Mailing Address - Country:US
Mailing Address - Phone:832-283-1086
Mailing Address - Fax:713-400-1932
Practice Address - Street 1:4315 CEDAR RIDGE TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3115
Practice Address - Country:US
Practice Address - Phone:832-283-1086
Practice Address - Fax:713-400-1932
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor