Healthcare Provider Details

I. General information

NPI: 1801916523
Provider Name (Legal Business Name): NATHAN JON HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD.
COVINGTON LA
70433-8107
US

IV. Provider business mailing address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2828
  • Fax: 734-936-9091
Mailing address:
  • Phone: 504-842-4000
  • Fax: 734-936-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD.204020
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: