Healthcare Provider Details

I. General information

NPI: 1629185970
Provider Name (Legal Business Name): ROBERT J HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 SUTTER ST THIRD FLOOR
SAN FRANCISCO CA
94115-3006
US

IV. Provider business mailing address

2380 SUTTER ST THIRD FLOOR
SAN FRANCISCO CA
94115-3006
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7580
  • Fax: 415-771-4472
Mailing address:
  • Phone: 415-885-7580
  • Fax: 415-771-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG43031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: