Provider Demographics
NPI:1821010299
Name:GARRETT PRICE, IVORY CAL (MD)
Entity Type:Individual
Prefix:
First Name:IVORY
Middle Name:CAL
Last Name:GARRETT PRICE
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 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-7579
Mailing Address - Country:US
Mailing Address - Phone:806-467-5700
Mailing Address - Fax:
Practice Address - Street 1:50 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4406
Practice Address - Country:US
Practice Address - Phone:806-467-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0194207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22886Medicare UPIN
TXTXB122843Medicare PIN