Healthcare Provider Details

I. General information

NPI: 1801981360
Provider Name (Legal Business Name): HARRY HARRISON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5010
US

IV. Provider business mailing address

PO BOX 430
AUBURN WA
98071-0430
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5525
  • Fax:
Mailing address:
  • Phone: 425-656-5525
  • Fax: 425-656-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberMD00024306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: