Provider Demographics
NPI:1992874606
Name:HARRISON, CASSANDRA CLARE (MD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:CLARE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 E SPEEDWAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3928
Mailing Address - Country:US
Mailing Address - Phone:520-833-5171
Mailing Address - Fax:520-318-7101
Practice Address - Street 1:890 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602
Practice Address - Country:US
Practice Address - Phone:520-498-6467
Practice Address - Fax:520-531-1424
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79359207R00000X
AZ27812207R00000X
GA057177207R00000X
AL26573207R00000X
IL036-069252207R00000X
MN35270207R00000X
MI4301056729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265567500Medicaid
AZ27812OtherAZ LICENSE
D16149Medicare UPIN