Provider Demographics
NPI:1962488221
Name:HARRISON, ERIC EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EDWARD
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 1:1504 W MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2806
Mailing Address - Country:US
Mailing Address - Phone:813-323-5447
Mailing Address - Fax:
Practice Address - Street 1:1504 W MORRISON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2806
Practice Address - Country:US
Practice Address - Phone:813-323-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015986207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035331100Medicaid
DCD58102Medicare UPIN
FL035331100Medicaid