Healthcare Provider Details

I. General information

NPI: 1487817003
Provider Name (Legal Business Name): HARMON DOCTORS' CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 ARMY DR
DEDEDO GU
96929-6520
US

IV. Provider business mailing address

2214 ARMY DR
DEDEDO GU
96929-6520
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberM 910
License Number StateGU

VIII. Authorized Official

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