Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 94-08935 | KS |
Y | 111NI0900X | Internist | 94-08935 | KS |
NPI | 1003263419 |
---|---|
Provider Name | Matthew Harrison |
First Address | Kansas City, KS 66160-8500 |
Second Address | Kansas City, KS 66160-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 20/06/2016 |