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General NPI Number Information
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NPI Number | 1225216054
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Entity Type | Individual
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Provider Name | ELIZABETH AVIS HARRISON MD
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Gender | Female
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 4488 FOREST PARK AVE STE 230
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2283
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Country | US
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Telephone | 314-535-7855
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Fax | 314-534-2803
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Provider Business Mailing Address
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Address Line | PO BOX 7412021
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City | CHICAGO
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State | IL
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Zip | 60674-2021
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Country | US
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Telephone | 314-535-7855
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Fax | 314-534-2803
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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 | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 2009012114
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2009012114
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License Number State | MO
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