Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 29475 | SC |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 200300344 | NC |
NPI | 1295842029 |
---|---|
Provider Name | Jeffrey Bruce Garris |
First Address | Fletcher, NC 28732-1869 |
Second Address | Arden, NC 28704-7714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137UJ | BCBS NC (01) | NC |
294755 | (05) | SC |
F92698 | (02) | SC |
P00656891 | RR MEDICARE (01) | SC |
P01452618 | RR MEDICARE/NC (01) | NC |