Healthcare Provider Details

I. General information

NPI: 1922037423
Provider Name (Legal Business Name): LAWRENCE R. HARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 SW 1ST AVE
OCALA FL
34474-4001
US

IV. Provider business mailing address

PO BOX 3130
OCALA FL
34478-3130
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8311
  • Fax: 352-622-5771
Mailing address:
  • Phone: 352-867-8311
  • Fax: 352-622-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME78441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: