Provider Demographics
NPI:1396934188
Name:HARRISON, ALEX T (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:T
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4825
Mailing Address - Country:US
Mailing Address - Phone:805-928-0610
Mailing Address - Fax:805-928-0680
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-928-0610
Practice Address - Fax:805-928-0680
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2014-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA89322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease