Provider Demographics
NPI:1740576842
Name:PAMELA R. GARNER D.O. PLLC
Entity Type:Organization
Organization Name:PAMELA R. GARNER D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-327-6880
Mailing Address - Street 1:410 4TH ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2372
Mailing Address - Country:US
Mailing Address - Phone:580-327-6880
Mailing Address - Fax:580-327-6891
Practice Address - Street 1:410 4TH ST
Practice Address - Street 2:SUITE K
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2372
Practice Address - Country:US
Practice Address - Phone:580-327-6880
Practice Address - Fax:580-327-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4409208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1164561353OtherNPI-PERSONAL