Provider Demographics
NPI:1487690194
Name:HARRISON, WILLIAM L (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:ALEGENT BERGAN MERCY HOSPITAL - DEPT OF RADIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-398-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA229242085R0202X
NE153692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04133OtherNEBRASKA BCBS
IA6992354Medicaid
IA7992354Medicaid
21011OtherIOWA BCBS
22924OtherIA LICENSE #
IA3992354Medicaid
IA8992354Medicaid
IA9992354Medicaid
1045OtherMIDLANDS
IA1954719Medicaid
BH6960947OtherIA CONTROLLED SUBSTANCE
15369OtherNE LICENSE #
15369OtherNE LICENSE #
NE088366Medicare PIN
1045OtherMIDLANDS
21011OtherIOWA BCBS