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General NPI Number Information
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NPI Number | 1518991702
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Entity Type | Organization
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Legal Business Name | JOHN WYATT HARRISON MD PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1930 E THOMAS ROAD
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City | PHOENIX
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State | AZ
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Zip | 85016-7711
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Country | US
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Telephone | 480-596-8525
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Fax | 480-596-8522
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Provider Business Mailing Address
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Address Line | PO BOX 26904
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City | PHOENIX
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State | AZ
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Zip | 85068-6904
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Country | US
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Telephone | 480-596-8525
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Fax | 480-596-8522
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOHN WYATT HARRISON
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Credential | M.D.
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Telephone | 480-596-8525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35565
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License Number State | AZ
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