Provider Demographics
NPI:1154307551
Name:HARRISON, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:719 W COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3011
Practice Address - Country:US
Practice Address - Phone:903-342-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4426207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-002OtherTRICARE
TX8AP489OtherBCBS
TX153373907Medicaid
TX75-0818167-048OtherTRICARE
TX0084LGOtherBCBS
TX153373903Medicaid
TX8EZ014OtherBCBS
TXTIN PLUS 044OtherTRICARE
TX153373904Medicaid
TX75-0818167-015OtherTRICARE
TX8ET746OtherBCBS
TX75-0818167-022OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8E2011OtherBCBS
TX930121754OtherMEDICARE RAILROAD
TX153373901Medicaid
TX8F6631OtherBCBS
TX75-0818167-022OtherTRICARE
TX153373901Medicaid
TX75-0818167-015OtherTRICARE
TX8ET746OtherBCBS
TXP00165459Medicare PIN
TX610657Medicare PIN