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General NPI Number Information
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NPI Number | 1730133489
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Entity Type | Individual
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Provider Name | JOHN WYATT HARRISON MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 6750 E BAYWOOD AVE
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City | MESA
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State | AZ
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Zip | 85206-1749
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Country | US
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Telephone | 480-321-4102
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Fax |
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Provider Business Mailing Address
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Address Line | 8144 E CACTUS RD SUITE 800
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5266
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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 |
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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 | 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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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 43224
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35565
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License Number State | AZ
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