Provider Demographics
NPI:1649236399
Name:HARRISON, ANDREW ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4986 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2748
Mailing Address - Country:US
Mailing Address - Phone:408-225-8149
Mailing Address - Fax:408-265-9965
Practice Address - Street 1:4986 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2748
Practice Address - Country:US
Practice Address - Phone:408-225-8149
Practice Address - Fax:408-265-9965
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3622213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82771Medicare UPIN
CA000E36223Medicare PIN