Provider Demographics
NPI:1912108051
Name:HARRISON, MATTHEW JAMES (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
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 1:511 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3403
Mailing Address - Country:US
Mailing Address - Phone:805-963-9377
Mailing Address - Fax:805-962-2154
Practice Address - Street 1:5333 HOLLISTER AVE STE 160
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2454
Practice Address - Country:US
Practice Address - Phone:805-964-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115319207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14108Medicare PIN