=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669452389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JAMES HARRISON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | DEPARTMENT ANESTHESIA NAVAL HOSPITAL CHERRY POINT MCAS CHERRY POINT
-----------------------------------------------------
City | HAVELOCK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-466-0486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 929 COMMONS DR N
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-8178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-937-0907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | G76056
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------