Provider Demographics
NPI:1629029467
Name:HARRIS, GERALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:HARRIS
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 1:925 N 87TH ST
Mailing Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4812
Mailing Address - Country:US
Mailing Address - Phone:414-456-2020
Mailing Address - Fax:414-456-6300
Practice Address - Street 1:925 N 87TH ST
Practice Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4812
Practice Address - Country:US
Practice Address - Phone:414-456-2020
Practice Address - Fax:414-456-6300
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20742207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000119XOtherHUMANA
WI1629029467Medicaid
002000119XOtherHUMANA
B53425Medicare UPIN