Provider Demographics
NPI:1689955767
Name:ANESIA K. GARMON, DO PA
Entity Type:Organization
Organization Name:ANESIA K. GARMON, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANESIA
Authorized Official - Middle Name:KHVOROFF
Authorized Official - Last Name:GARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-341-7626
Mailing Address - Street 1:902 FOSTER LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5714
Mailing Address - Country:US
Mailing Address - Phone:817-341-7626
Mailing Address - Fax:817-596-9771
Practice Address - Street 1:902 FOSTER LN
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5714
Practice Address - Country:US
Practice Address - Phone:817-341-7626
Practice Address - Fax:817-596-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033831101Medicaid
TXA66602Medicare UPIN
TX033831101Medicaid