Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD0039603 | TN |
Y | 111NI0900X | Internist | MD0039603 | TN |
N | 207RA0401X | Internist - Addiction Medicine | 39603 | TN |
NPI | 1982640140 |
---|---|
Provider Name | Dr. Jose Garrido |
First Address | Bulls Gap, TN 37711-3433 |
Second Address | Bulls Gap, TN 37711-3433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010186285 | (05) | VA |
3332506 | (05) | TN |
3332507 | (05) | TN |
G17899 | (02) |