Provider Demographics
NPI:1174505960
Name:GARRISON, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 S MAIN ST
Mailing Address - Street 2:MAIN MEDICAL PLAZA, SUITE B-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5224
Mailing Address - Country:US
Mailing Address - Phone:713-797-6000
Mailing Address - Fax:713-797-9090
Practice Address - Street 1:10021 S MAIN ST
Practice Address - Street 2:MAIN MEDICAL PLAZA, SUITE B-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5224
Practice Address - Country:US
Practice Address - Phone:713-797-6000
Practice Address - Fax:713-797-9090
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8121208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15971Medicare UPIN