Provider Demographics
NPI:1528140068
Name:HARRIS, GERALD RAY (DO)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:RAY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1550 W ROSEDALE ST
Mailing Address - Street 2:SUITE 714
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-336-4810
Mailing Address - Fax:817-336-4802
Practice Address - Street 1:1550 W ROSEDALE ST
Practice Address - Street 2:SUITE 714
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-336-4810
Practice Address - Fax:817-336-4802
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9519207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99849Medicare UPIN