Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G50780 | CA |
N | 207K00000X | Allergist & Immunologist | G50780 | CA |
N | 207N00000X | Dermatologist | G50780 | CA |
Y | 207Q00000X | Family Doctor | G50780 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G50780 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | G50780 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G50780 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | G50780 | CA |
N | 207R00000X | Internist | G50780 | CA |
N | 111NI0900X | Internist | G50780 | CA |
N | 207V00000X | Obstetrician & Gynecologist | G50780 | CA |
N | 208000000X | Pediatrician | G50780 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | G50780 | CA |
NPI | 1295814408 |
---|---|
Provider Name | Dr. Ric Scott Garrison |
First Address | Palmdale, CA 93551-1447 |
Second Address | Palmdale, CA 93551-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 06/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93004 | (02) | CA |