Provider Demographics
NPI:1407815020
Name:GARRISON, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:GARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650823
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0823
Mailing Address - Country:US
Mailing Address - Phone:972-884-4390
Mailing Address - Fax:972-674-2616
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:ATTN: MIT/M RUIZ
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:972-884-4390
Practice Address - Fax:972-674-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9649208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110134701Medicaid
C15972Medicare UPIN
TX8734J1Medicare PIN