Healthcare Provider Details

I. General information

NPI: 1255396255
Provider Name (Legal Business Name): DAVID THOMAS HARRISON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GUION RD STE 330
INDIANAPOLIS IN
46222-1697
US

IV. Provider business mailing address

8314 EAGLE CREST LN
INDIANAPOLIS IN
46234-9528
US

V. Phone/Fax

Practice location:
  • Phone: 317-923-1033
  • Fax: 317-927-7426
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number02000816
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: