Individual
DR. GORDON A HARRIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5400 N MAIN ST, DAYTON, OH 45415-3453
(937) 274-2226
(937) 274-2074
Mailing address
5400 N MAIN ST, DAYTON, OH 45415-3453
(937) 274-2226
(937) 274-2074
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2051
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000008354
ANTHEM PIN #
OH
01
—
0004126935
AETNA PROVIDER #
OH
01
—
054917
VALUE OPTIONS PROVIDER #
OH
Enumeration date
03/25/2006
Last updated
07/08/2007
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