Provider Demographics
NPI:1497762033
Name:GARMON, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:GARMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:DAVID
Other - Last Name:GARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:230 W PALM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5523
Mailing Address - Country:US
Mailing Address - Phone:858-535-9121
Mailing Address - Fax:858-623-8519
Practice Address - Street 1:230 W PALM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5523
Practice Address - Country:US
Practice Address - Phone:858-535-9121
Practice Address - Fax:858-623-8519
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC419162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C419160Medicaid
CA00C419160Medicaid
CAC41916Medicare ID - Type Unspecified