Provider Demographics
NPI:1316910102
Name:BACHRACH, HARRISON J (MD)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:J
Last Name:BACHRACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 S WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2472
Mailing Address - Country:US
Mailing Address - Phone:602-615-5619
Mailing Address - Fax:
Practice Address - Street 1:8634 S WILLOW DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2472
Practice Address - Country:US
Practice Address - Phone:602-615-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-05-16
Deactivation Date:2017-10-30
Deactivation Code:
Reactivation Date:2018-05-16
Provider Licenses
StateLicense IDTaxonomies
AZ17873207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279720Medicaid
AZ279720Medicaid
AZZ149589Medicare PIN