Provider Demographics
NPI:1184652141
Name:HARRISON, PRESTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:E
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 1:1301 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2239
Mailing Address - Country:US
Mailing Address - Phone:903-597-3787
Mailing Address - Fax:903-593-4052
Practice Address - Street 1:1301 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2239
Practice Address - Country:US
Practice Address - Phone:903-597-3787
Practice Address - Fax:903-593-4052
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD70802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG0029809OtherDPS
TXG0029809OtherDPS
TXG0029809OtherDPS