Provider Demographics
NPI:1801815428
Name:HARRIS, THOMAS GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GREGORY
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:PO BOX 90730
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-0730
Mailing Address - Country:US
Mailing Address - Phone:626-795-8051
Mailing Address - Fax:626-795-0356
Practice Address - Street 1:800 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3229
Practice Address - Country:US
Practice Address - Phone:626-795-8051
Practice Address - Fax:626-795-0356
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90250207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00432226OtherRAIL ROAD MEDICARE
CABD761ZOtherMEDICARE PIN
CAI32192Medicare UPIN
CAWA90250BMedicare PIN