Provider Demographics
NPI:1033399704
Name:DAVID T. HARRISON, D.O.,P.C.
Entity Type:Organization
Organization Name:DAVID T. HARRISON, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-923-1033
Mailing Address - Street 1:3520 GUION RD STE 307
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1672
Mailing Address - Country:US
Mailing Address - Phone:317-923-1033
Mailing Address - Fax:317-927-7426
Practice Address - Street 1:3520 GUION RD STE 307
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1672
Practice Address - Country:US
Practice Address - Phone:317-923-1033
Practice Address - Fax:317-927-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000816208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265480Medicare PIN