Healthcare Provider Details

I. General information

NPI: 1952621468
Provider Name (Legal Business Name): VICTOR SANOE HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2.6 MILE ZIMOVIA HWY
WRANGELL AK
99929
US

IV. Provider business mailing address

2.6 MILE ZIMOVIA HWY
WRANGELL AK
99929
US

V. Phone/Fax

Practice location:
  • Phone: 360-217-9392
  • Fax: 907-560-8508
Mailing address:
  • Phone: 360-217-9392
  • Fax: 907-560-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMT205547
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR72115
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR72115
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: