Provider Demographics
NPI:1689692865
Name:GARRISON, JARED DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DANIEL
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2601
Mailing Address - Country:US
Mailing Address - Phone:530-934-1816
Mailing Address - Fax:530-934-1991
Practice Address - Street 1:1133 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2601
Practice Address - Country:US
Practice Address - Phone:530-934-1816
Practice Address - Fax:530-934-1991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74084Medicare UPIN