Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | IL |
NPI | 1003920950 |
---|---|
Provider Name | Dr. Gregory T Garrison |
First Address | Swansea, IL 62226-2038 |
Second Address | Swansea, IL 62226-2038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |