Provider Demographics
NPI:1073573630
Name:HARRISON, ALAN RICHARD JR (PA)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:RICHARD
Last Name:HARRISON
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:7373 FRANCE AVE S.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4538
Mailing Address - Country:US
Mailing Address - Phone:952-428-0500
Mailing Address - Fax:952-428-0501
Practice Address - Street 1:7373 FRANCE AVE S.
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4538
Practice Address - Country:US
Practice Address - Phone:952-428-0500
Practice Address - Fax:952-428-0501
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-04-16
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Provider Licenses
StateLicense IDTaxonomies
MN9306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64940Medicare UPIN
MN970004145Medicare PIN