Healthcare Provider Details

I. General information

NPI: 1174686323
Provider Name (Legal Business Name): GEORGE P MACRIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 ARMY DRIVE HARMON
DEDEDO GU
96929
US

IV. Provider business mailing address

2214 ARMY DRIVE HARMON
DEDEDO GU
96929
US

V. Phone/Fax

Practice location:
  • Phone: 671-637-1777
  • Fax: 671-637-4385
Mailing address:
  • Phone: 671-637-1777
  • Fax: 671-637-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM000910
License Number StateGU

VIII. Authorized Official

Name: DR. GEORGE P MACRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 671-637-1777