Provider Demographics
NPI:1295718013
Name:HARRISON, WILLIAM ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
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 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-996-1560
Mailing Address - Fax:307-996-1565
Practice Address - Street 1:800 E 20TH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3859
Practice Address - Country:US
Practice Address - Phone:307-996-1560
Practice Address - Fax:307-996-1565
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5769A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5769AOtherSTATE LICENSE
WY110746100Medicaid
WY710WH95OtherSUBSTANCE CONTROL
WY5769AOtherSTATE LICENSE
WY710WH95OtherSUBSTANCE CONTROL