Provider Demographics
NPI:1689676165
Name:HARRIS, GERALD BARNES II (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:BARNES
Last Name:HARRIS
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 N 91ST AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8390
Mailing Address - Country:US
Mailing Address - Phone:623-877-0100
Mailing Address - Fax:623-328-8713
Practice Address - Street 1:8914 N 91ST AVE STE 100A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8390
Practice Address - Country:US
Practice Address - Phone:623-877-0100
Practice Address - Fax:623-328-8713
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4027207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689676165OtherTYPE I NPI
1750598108OtherTYPE II NPI
AZ961252Medicaid
H69151Medicare UPIN