MEDICARE: DAVID THOMAS HARRISON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	02000816	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01424321	OTHER	IN	RAIL ROAD PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000727646	OTHER	IN	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255396255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID THOMAS HARRISON DO

Provider Business Mailing Address
First Line	:	8314 EAGLE CREST LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-9528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 GUION RD
Second Line	:	STE 330
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1697
Country	:	US
Telephone Number	:	317-923-1033
Fax Number	:	317-927-7426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/07/2024

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Directions to “ DAVID THOMAS HARRISON DO” Practice Location

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