Provider Demographics
NPI:1649268483
Name:HARRISON, CRAIG E (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
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 1:1100 E LAKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3343
Mailing Address - Country:US
Mailing Address - Phone:903-535-7722
Mailing Address - Fax:903-535-7878
Practice Address - Street 1:1100 E LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3343
Practice Address - Country:US
Practice Address - Phone:903-535-7722
Practice Address - Fax:903-535-7878
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7068208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE48604Medicare UPIN
TX00L87TMedicare ID - Type Unspecified