Provider Demographics
NPI:1336569433
Name:GARMON, GENNIFER MEILYSE
Entity Type:Individual
Prefix:
First Name:GENNIFER
Middle Name:MEILYSE
Last Name:GARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6537 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2610
Mailing Address - Country:US
Mailing Address - Phone:972-484-7700
Mailing Address - Fax:972-484-7718
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 325
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2175
Practice Address - Country:US
Practice Address - Phone:817-887-9389
Practice Address - Fax:817-887-9392
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1101207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease