Provider Demographics
NPI:1336445055
Name:MACRIS, GEORGE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:MACRIS
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 1:2214 ARMY DR
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6520
Mailing Address - Country:US
Mailing Address - Phone:671-637-1777
Mailing Address - Fax:671-637-4385
Practice Address - Street 1:2214 ARMY DR
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6520
Practice Address - Country:US
Practice Address - Phone:671-637-1777
Practice Address - Fax:671-637-4385
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5868207P00000X, 2083P0011X, 207R00000X
ORMD150758207P00000X, 207R00000X, 2083P0011X
MP0350207P00000X, 207R00000X, 2083P0011X
FLME59448207P00000X, 207R00000X, 2083P0011X
NJME59448207P00000X, 2083P0011X
NJMA40955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000ZGBDGOtherCURRY GENERAL HOSPITAL - MEDICARE PART B
OR500630865Medicaid
OR381322OtherCURRY GENERAL HOSPITAL - MEDICARE PART A
OR0000ZGBDGOtherCURRY GENERAL HOSPITAL - MEDICARE PART B
OR500630865Medicaid