Healthcare Provider Details

I. General information

NPI: 1194801605
Provider Name (Legal Business Name): NEDRA J HARRISON MD FACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 E MOUNTAIN VIEW RD STE 102
SCOTTSDALE AZ
85258-5134
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-6888
  • Fax: 833-640-8848
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28264
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: