1477726529 NPI number — DR. MATTHEW LEE HARRISON D.O., M.P.H.

Table of content: DR. MATTHEW LEE HARRISON D.O., M.P.H. (NPI 1477726529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477726529 NPI number — DR. MATTHEW LEE HARRISON D.O., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
MATTHEW
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O., M.P.H.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477726529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3649 S HILLS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76109-2754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-944-3627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11801 SOUTH FREEWAY
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT.
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-551-2597
Provider Business Practice Location Address Fax Number:
817-568-3340
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  P0729 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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