Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4027 | AZ |
N | 111NI0900X | Internist | 4027 | AZ |
Y | 207RA0401X | Internist - Addiction Medicine | 4027 | AZ |
NPI | 1689676165 |
---|---|
Provider Name | Dr. Gerald Barnes Harris II |
First Address | Glendale, AZ 85308-8463 |
Second Address | Glendale, AZ 85308-8463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1689676165 | TYPE I NPI (01) | |
1750598108 | TYPE II NPI (01) | |
961252 | (05) | AZ |
H69151 | (02) |