Provider Demographics
NPI:1750598108
Name:DR GERALD B HARRIS II LLC
Entity type:Organization
Organization Name:DR GERALD B HARRIS II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:623-977-0700
Mailing Address - Street 1:10930 W CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5905
Mailing Address - Country:US
Mailing Address - Phone:623-977-0700
Mailing Address - Fax:623-977-2315
Practice Address - Street 1:10615 W. THUNDERBIRD
Practice Address - Street 2:STE. B-200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3055
Practice Address - Country:US
Practice Address - Phone:623-977-0700
Practice Address - Fax:623-977-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961252Medicaid
AZ961252Medicaid
AZH69151Medicare UPIN