Healthcare Provider Details

I. General information

NPI: 1518998541
Provider Name (Legal Business Name): WILLIAM A HARRISON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 201
ALBUQUERQUE NM
87109-1226
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE SUITE 201
ALBUQUERQUE NM
87109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-0443
  • Fax: 505-205-1057
Mailing address:
  • Phone: 505-888-0443
  • Fax: 505-205-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberNM79174
License Number StateNM

VIII. Authorized Official

Name: WENDY MARIE LEWIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-565-5512