Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036076625 | IL |
NPI | 1003807157 |
---|---|
Provider Name | Dr. Murke Franklin Harrison |
First Address | Mount Vernon, IL 62864-0015 |
Second Address | Mount Vernon, IL 62864-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036076625 | (05) | IL |
04122575 | BCBS (01) | IL |
E47438 | (02) |