Provider Demographics
NPI:1790778942
Name:HARRISON, EARL R JR (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:R
Last Name:HARRISON
Suffix:JR
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 1540
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1540
Mailing Address - Country:US
Mailing Address - Phone:406-265-5827
Mailing Address - Fax:406-265-5949
Practice Address - Street 1:30 13TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5222
Practice Address - Country:US
Practice Address - Phone:406-265-5827
Practice Address - Fax:406-265-5949
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-04-20
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MT4750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1778-0OtherBC
MO300018917OtherRR MEDICARE
MT0071591Medicaid
MO300018917OtherRR MEDICARE
D96277Medicare UPIN