Healthcare Provider Details

I. General information

NPI: 1487628574
Provider Name (Legal Business Name): DAVID HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 LYONS RD SUITE 110
COCONUT CREEK FL
33073-3481
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 954-971-3210
  • Fax: 954-971-3427
Mailing address:
  • Phone: 954-971-3210
  • Fax: 954-971-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME47299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: