Provider Demographics
NPI:1295842029
Name:GARRIS, JEFFREY BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRUCE
Last Name:GARRIS
Suffix:
Gender:M
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:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5698
Mailing Address - Fax:
Practice Address - Street 1:15 SKYLAND INN DR
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7714
Practice Address - Country:US
Practice Address - Phone:828-654-5005
Practice Address - Fax:828-654-3257
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29475207V00000X
NC200300344207VF0040X, 207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01452618OtherRR MEDICARE/NC
SCP00656891OtherRR MEDICARE
SC294755Medicaid
NC137UJOtherBCBS NC
NC2032690AMedicare PIN
NCP01452618OtherRR MEDICARE/NC
SCF926983640Medicare PIN
SCF92698Medicare UPIN