Provider Demographics
NPI:1639128242
Name:GARRIS, JOEL BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BENNETT
Last Name:GARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 WHITTIER BLVD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3939
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-309-8200
Practice Address - Street 1:12401 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-306-8200
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA789432085R0202X
CAG297132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99326Medicare UPIN