Provider Demographics
NPI:1912957762
Name:HARRISON, EMMANUEL ELMO (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ELMO
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 911589
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1589
Mailing Address - Country:US
Mailing Address - Phone:214-946-1133
Mailing Address - Fax:217-946-3048
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAVILION II SUITE 845
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-1133
Practice Address - Fax:214-946-3048
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1879207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144381402Medicaid
TX144381404Medicaid
G28368Medicare UPIN
TX144381404Medicaid
TX8A1021Medicare PIN