MEDICARE: DR. GERALD BARNES HARRIS II DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4027	AZ
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	4027	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1689676165	OTHER	TYPE I NPI
2	1750598108	OTHER	TYPE II NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689676165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD BARNES HARRIS II DO

Provider Business Mailing Address
First Line	:	8914 N 91ST AVE STE 100A
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-8390
Country	:	US
Telephone Number	:	623-877-0100
Fax Number	:	623-328-8713

Provider Business Practice Location Address
First Line	:	8914 N 91ST AVE STE 100A
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-8390
Country	:	US
Telephone Number	:	623-877-0100
Fax Number	:	623-328-8713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/11/2022

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