Provider Demographics
NPI:1396768180
Name:HARRISON, ANDREW RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 493
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-4400
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHY, PWB NINTH FLOOR, CLINIC 9A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41476207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN844861OtherARAZ
MN130528000Medicaid
MN127127OtherUCARE
MN22L41HAOtherBCBS
MT0055393Medicaid
MN08-00184OtherMEDICA CHOICE
MN08-00043OtherMEDICA PRIMARY
MN1020136OtherPREFERRED ONE
MNHP29088OtherHEALTHPARTNERS
MT0055393Medicaid