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General NPI Number Information
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NPI Number | 1073918215
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Entity Type | Individual
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Provider Name | STEVEN VANCE HARRISON III PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 370 E VIRGINIA AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85004-1254
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Country | US
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Telephone | 602-258-4788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7587
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City | PHOENIX
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State | AZ
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Zip | 85011-7587
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Country | US
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Telephone | 602-258-4788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52074
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 6077
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License Number State | AZ
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