Healthcare Provider Details

I. General information

NPI: 1720065253
Provider Name (Legal Business Name): DOUGLAS G HARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W 16TH ST
SAFFORD AZ
85546-4026
US

IV. Provider business mailing address

PO BOX 2660
THATCHER AZ
85552-2660
US

V. Phone/Fax

Practice location:
  • Phone: 928-424-4444
  • Fax: 928-424-4446
Mailing address:
  • Phone: 928-424-4444
  • Fax: 928-424-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number053918
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number41204
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: