Individual
JACK AUSTIN HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
188 LONGWOOD AVE, BOSTON, MA 02115-5819
(617) 432-1434
Mailing address
40 CHESTERFIELD LAKES RD, CHESTERFIELD, MO 63005-4506
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/13/2022
Last updated
03/13/2022
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