Provider Demographics
NPI:1497995401
Name:ALEX HARRISON, M.D., INC.
Entity Type:Organization
Organization Name:ALEX HARRISON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-0610
Mailing Address - Street 1:1510 E MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4826
Mailing Address - Country:US
Mailing Address - Phone:805-928-0610
Mailing Address - Fax:
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4826
Practice Address - Country:US
Practice Address - Phone:805-928-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497995401Medicaid
CA1497995401Medicaid