Provider Demographics
NPI:1518037431
Name:GARRISON, CALVIN (PA)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PA
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 689
Mailing Address - Street 2:
Mailing Address - City:HANNA
Mailing Address - State:WY
Mailing Address - Zip Code:82327-0689
Mailing Address - Country:US
Mailing Address - Phone:307-325-6596
Mailing Address - Fax:307-325-6597
Practice Address - Street 1:1008 FELDSPAR COURT
Practice Address - Street 2:
Practice Address - City:HANNA
Practice Address - State:WY
Practice Address - Zip Code:82327
Practice Address - Country:US
Practice Address - Phone:307-325-6596
Practice Address - Fax:307-325-6597
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY00863001OtherBLUE CROSS BLUE SHIELD
WYP00029818OtherRR MEDICARE
WY83600002582327A002OtherTRICARE
WY1399310OtherUMWA
WY308221Medicare ID - Type Unspecified
WY4370549Medicare ID - Type UnspecifiedMEDICARE GROUP
WY00863001OtherBLUE CROSS BLUE SHIELD
WYS72101Medicare UPIN