Provider Demographics
NPI:1720026867
Name:HARRIMAN, GERALD ARTHUR (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ARTHUR
Last Name:HARRIMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1050 W WESTERN AVE
Mailing Address - Street 2:400
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1694
Mailing Address - Country:US
Mailing Address - Phone:231-728-3442
Mailing Address - Fax:231-722-0708
Practice Address - Street 1:1050 W WESTERN AVE
Practice Address - Street 2:400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1694
Practice Address - Country:US
Practice Address - Phone:231-728-3442
Practice Address - Fax:231-722-0708
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009348207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1739797Medicaid
MI1739797Medicaid