Healthcare Provider Details

I. General information

NPI: 1639141013
Provider Name (Legal Business Name): TERRY ALAN HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE KAISER PERMANENTE MEDICAL CENTER
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

14635 WYE ST
SAN DIEGO CA
92129-1631
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-3697
  • Fax: 619-528-6933
Mailing address:
  • Phone: 858-672-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA043784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: