Basic Information
| Provider Information | |||||||||
| NPI: | 1154764405 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. RUSSELL B HARRISON, MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARRISON FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1125 | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978010100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412151564 | ||||||||
| FaxNumber: | 5412151567 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 SOUTHGATE STE 2 | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412151564 | ||||||||
| FaxNumber: | 5412151567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRISON | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 5412151564 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | MD29141 | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.