Healthcare Provider Details

I. General information

NPI: 1396768180
Provider Name (Legal Business Name): ANDREW RICHARD HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE STREET SE UNIVERSITY OF MINNESOTA PHY, PWB NINTH FLOOR, CLINIC 9A
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE STREET SE, MMC 493 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-4400
  • Fax:
Mailing address:
  • Phone: 612-625-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41476
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number41476
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: