Individual
DR. JONATHAN HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-4423
Mailing address
2020 PALOMINO LN STE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
72627
AZ
2085R0202X
Diagnostic Radiology Physician
17033
NV
2085R0204X
Vascular & Interventional Radiology Physician
Primary
11351657-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326113311
—
NV
01
—
17033
NEVADA MEDICAL LICENSE
NV
01
—
72627
ARIZONA PERMIT BOARD
AZ
Enumeration date
05/26/2011
Last updated
11/27/2024
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