Provider Demographics
NPI:1194801605
Name:HARRISON, NEDRA J (MD FACS)
Entity type:Individual
Prefix:DR
First Name:NEDRA
Middle Name:J
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 39179
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9179
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:9220 E MOUNTAIN VIEW RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5134
Practice Address - Country:US
Practice Address - Phone:480-470-6888
Practice Address - Fax:833-640-8848
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28264208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP01554248OtherRR MEDICARE
AZ3721790OtherCIGNA
AZ5250332OtherAETNA
B36158Medicare UPIN
AZZ63317Medicare PIN
AZZ180880Medicare PIN