Provider Demographics
NPI:1194773135
Name:HARRISON, JEFFREY J (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:253-857-1489
Practice Address - Street 1:4700 POINT FOSDICK DR STE 202
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:253-857-1489
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043221Medicaid
WA8939224OtherSTATE CRIME VICTIMS
WA0189805OtherSTATE L&I
WAP00209102OtherRAILROAD
WA8806577Medicare ID - Type Unspecified
WAG8806577Medicare PIN
WA0189805OtherSTATE L&I
WAP00209102OtherRAILROAD
WA8939224OtherSTATE CRIME VICTIMS