Provider Demographics
NPI:1740415173
Name:HARRIS, GILBERT WAYNE
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:WAYNE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4288 W GULF DR
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-5104
Mailing Address - Country:US
Mailing Address - Phone:239-395-0850
Mailing Address - Fax:239-395-0850
Practice Address - Street 1:4288 W GULF DR
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-5104
Practice Address - Country:US
Practice Address - Phone:239-395-0850
Practice Address - Fax:239-395-0850
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0018027207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology