Provider Demographics
NPI:1922037423
Name:HARRISON, LAWRENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
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 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-622-5771
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4001
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-622-5771
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256716400Medicaid
FL46833TOtherMEDICARE PTAN MID FL CARDIOVASCULAR ANESTHESIA ASSOCIATES
FL46833OtherBCBS FL
FL46833TOtherMEDICARE PTAN MID FL CARDIOVASCULAR ANESTHESIA ASSOCIATES
FLE63490Medicare UPIN
FLP00109762Medicare PIN
FL46833OtherBCBS FL
FL46833WMedicare PIN
FL46833XMedicare PIN
FL46833ZMedicare PIN
FL050068035Medicare PIN
FL46833UMedicare PIN