Healthcare Provider Details

I. General information

NPI: 1437386224
Provider Name (Legal Business Name): HARRISON H GELLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W COLORADO AVE
COLORADO SPRINGS CO
80905-1518
US

IV. Provider business mailing address

910 W COLORADO AVE
COLORADO SPRINGS CO
80905-1518
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-3876
  • Fax: 719-219-3883
Mailing address:
  • Phone: 719-219-3876
  • Fax: 719-219-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: