Provider Demographics
NPI:1477974202
Name:JARED D GARRISON DO INC
Entity Type:Organization
Organization Name:JARED D GARRISON DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-934-2834
Mailing Address - Street 1:PO BOX 4581
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-4581
Mailing Address - Country:US
Mailing Address - Phone:530-898-1201
Mailing Address - Fax:530-898-1204
Practice Address - Street 1:1224 E ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987
Practice Address - Country:US
Practice Address - Phone:530-473-5321
Practice Address - Fax:530-473-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
CAPENDINGMedicaid