Healthcare Provider Details

I. General information

NPI: 1619010113
Provider Name (Legal Business Name): HARRISON UROLOGY CLINIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BOWER AVE
HARRISON AR
72601-3529
US

IV. Provider business mailing address

324 WEST BOWER ST. HARRISON UROLOGY CLINIC, P.A.
HARRISON AR
72601
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-9481
  • Fax: 870-741-4614
Mailing address:
  • Phone: 870-741-9481
  • Fax: 870-741-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberC-4026
License Number StateAR

VIII. Authorized Official

Name: DR. NOEL FRAZIER FERGUSON
Title or Position: OWNER
Credential: M.D.
Phone: 870-741-9481