Provider Demographics
NPI:1073609517
Name:HARRISON, SUZANNE H (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:H
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:3741 W 12600 S
Practice Address - Street 2:RIVERTON HOSPITAL
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-285-4000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5818388-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT41026OtherHEALTHY U
UT870545614HAROtherEDUCATORS MUTUAL
UTQM0000075886OtherALTIUS
WY121257500Medicaid
UT1502954OtherUMWA
UT83771OtherPEHP
UT915332OtherDESERET MUTUAL
UTQMP000003336800OtherMOLINA
NV100507329Medicaid
UT107041106101OtherIHC
UT58183881200001OtherBCBS
ID807197200Medicaid
UT2090168OtherUNITED HEALTHCARE
AZ947195Medicaid
UT58183881200001OtherBCBS
UTI46947Medicare UPIN