Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 17065 | KY |
Y | 208600000X | Surgeon | 17065 | KY |
N | 2086S0129X | Vascular Surgeon | 17065 | KY |
NPI | 1083663934 |
---|---|
Provider Name | Richard N Garrison |
First Address | Louisville, KY 40202-5700 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 30/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100359210B | (05) | IN |
1051113 | PASSPORT (01) | KY |
64170657 | (05) | KY |
C66337 | (02) |