Provider Demographics
NPI:1487626487
Name:GARRISON, EARL GENE JR (DO)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:GENE
Last Name:GARRISON
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:HC 60 BOX 135
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OK
Mailing Address - Zip Code:74536-9717
Mailing Address - Country:US
Mailing Address - Phone:918-569-4449
Mailing Address - Fax:
Practice Address - Street 1:1 CHOCTAW WAY
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2022
Practice Address - Country:US
Practice Address - Phone:918-567-7065
Practice Address - Fax:918-567-7090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2169207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3293913Medicaid