Healthcare Provider Details

I. General information

NPI: 1508859638
Provider Name (Legal Business Name): KURT DUDLEY HARRISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 GLEN SPRINGS DR.
FREMONT OH
43420
US

IV. Provider business mailing address

1922 GLEN SPRINGS DR.
FREMONT OH
43420
US

V. Phone/Fax

Practice location:
  • Phone: 419-333-9026
  • Fax: 419-333-9043
Mailing address:
  • Phone: 419-333-9026
  • Fax: 419-333-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34007809
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34007809H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: