Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 12618R | LA |
NPI | 1104849009 |
---|---|
Provider Name | Mr. Jeffrey L Garrison |
First Address | Alexandria, LA 71301 |
Second Address | Alexandria, LA 71301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1549452 | (05) | LA |
G65555 | (02) | |
G65555 | (02) | LA |