Provider Demographics
NPI:1780811158
Name:HARRISON, PAUL C (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:HARRISON
Suffix:
Gender:M
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 1:6507 S COOPER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5818
Mailing Address - Country:US
Mailing Address - Phone:817-466-9100
Mailing Address - Fax:817-466-9410
Practice Address - Street 1:6507 S COOPER ST STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-466-9100
Practice Address - Fax:817-466-9410
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31760207Q00000X
TXQ0929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168962332OtherGROUP NPI
AL529906610OtherMEDICAID GROUP #
AL141427Medicaid
AL511-28944OtherBC/BS
AL168962332OtherGROUP NPI
AL141427Medicaid