Healthcare Provider Details

I. General information

NPI: 1891759221
Provider Name (Legal Business Name): BRUCE E HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

IV. Provider business mailing address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-2536
  • Fax: 573-519-5347
Mailing address:
  • Phone: 573-547-2536
  • Fax: 573-519-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR5J59
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: