Provider Demographics
NPI:1174686323
Name:GEORGE P MACRIS MD PC
Entity Type:Organization
Organization Name:GEORGE P MACRIS MD PC
Other - Org Name:HARMON DOCTORS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-637-1777
Mailing Address - Street 1:2214 ARMY DRIVE
Mailing Address - Street 2:HARMON
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-637-1777
Mailing Address - Fax:671-637-4385
Practice Address - Street 1:2214 ARMY DRIVE
Practice Address - Street 2:HARMON
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-637-1777
Practice Address - Fax:671-637-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM000910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C9609Medicare UPIN