Provider Demographics
NPI:1669761136
Name:HARRISON, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:511 OAKWOOD BLVD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4068
Mailing Address - Country:US
Mailing Address - Phone:512-244-3698
Mailing Address - Fax:512-244-0214
Practice Address - Street 1:511 OAKWOOD BLVD.
Practice Address - Street 2:SUITE 301
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4068
Practice Address - Country:US
Practice Address - Phone:512-244-3698
Practice Address - Fax:512-244-0214
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5423207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350006801Medicaid