Healthcare Provider Details

I. General information

NPI: 1710062187
Provider Name (Legal Business Name): HOWARD DAVID HARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 WINKLER AVENUE EXT VA OUTPATIENT CLINIC-FORT MEYERS
FORT MYERS FL
33916-9413
US

IV. Provider business mailing address

5358 MALIBU COURT
CAPE CORAL FL
33904
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-3939
  • Fax: 239-939-7641
Mailing address:
  • Phone: 239-540-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: