Healthcare Provider Details

I. General information

NPI: 1831162429
Provider Name (Legal Business Name): NORMAN DON HARRISON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S TELSHOR BLVD SUITE 104
LAS CRUCES NM
88011-5071
US

IV. Provider business mailing address

2525 S TELSHOR BLVD SUITE 104
LAS CRUCES NM
88011-5071
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-5156
  • Fax:
Mailing address:
  • Phone: 575-647-5156
  • Fax: 575-647-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-593-72
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: