Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1819 | WV |
Y | 207Q00000X | Family Doctor | 1819 | WV |
NPI | 1194758003 |
---|---|
Provider Name | John Mark Garlitz |
First Address | Lewisburg, WV 24901-1380 |
Second Address | Lewisburg, WV 24901-1380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11076564 | CAQH ID # (01) | |
1802009000 | (05) | WV |
G88230 | (02) |