Healthcare Provider Details

I. General information

NPI: 1912957762
Provider Name (Legal Business Name): EMMANUEL ELMO HARRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD PAVILION II SUITE 845
DALLAS TX
75208-2363
US

IV. Provider business mailing address

PO BOX 911589
DALLAS TX
75391-1589
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-1133
  • Fax: 214-946-3048
Mailing address:
  • Phone: 214-946-1133
  • Fax: 217-946-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL1879
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: