Healthcare Provider Details

I. General information

NPI: 1790778942
Provider Name (Legal Business Name): EARL HARRISON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date: 03/27/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

30 13TH ST
HAVRE MT
59501-5222
US

IV. Provider business mailing address

PO BOX 1540
HAVRE MT
59501-1540
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-5827
  • Fax:
Mailing address:
  • Phone: 406-265-5827
  • Fax: 406-265-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number4750
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: