Provider Demographics
NPI:1730176983
Name:HARRIS, GERALD EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWIN
Last Name:HARRIS
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 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-242-5433
Mailing Address - Fax:415-242-8904
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-242-5433
Practice Address - Fax:415-242-8904
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088860OtherMEDI-CAL
CAA38567Medicare UPIN