Provider Demographics
NPI:1245209303
Name:HARMON, GARY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:HARMON
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 1:1722 PINE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1158
Mailing Address - Country:US
Mailing Address - Phone:334-293-8736
Mailing Address - Fax:334-293-8738
Practice Address - Street 1:1801 PINE ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1154
Practice Address - Country:US
Practice Address - Phone:334-293-8138
Practice Address - Fax:334-293-8134
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026491208600000X, 208C00000X
ALMD.39106208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8155426Medicaid
WA546514Medicare ID - Type Unspecified
WA8155426Medicaid