Basic Information
| Provider Information | |||||||||
| NPI: | 1154307551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 719 W COKE RD | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754943011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033425227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L4426 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 8AP489 | 01 | TX | BCBS | OTHER | 153373907 | 05 | TX | MEDICAID | 75-0818167-048 | 01 | TX | TRICARE | OTHER | 0084LG | 01 | TX | BCBS | OTHER | 153373903 | 05 | TX | MEDICAID | 8EZ014 | 01 | TX | BCBS | OTHER | TIN PLUS 044 | 01 | TX | TRICARE | OTHER | 153373904 | 05 | TX | MEDICAID | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 8ET746 | 01 | TX | BCBS | OTHER | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8E2011 | 01 | TX | BCBS | OTHER | 930121754 | 01 | TX | MEDICARE RAILROAD | OTHER | 153373901 | 05 | TX | MEDICAID | 8F6631 | 01 | TX | BCBS | OTHER |