Provider Demographics
NPI:1780756460
Name:GARRISON, GREGORY M (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:GARRISON
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:PO BOX 628296
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32862-8296
Mailing Address - Country:US
Mailing Address - Phone:407-741-9418
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:2906 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6006
Practice Address - Country:US
Practice Address - Phone:407-425-4847
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073072207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44407OtherBCBS
FL44407OtherBCBS
FL44407ZMedicare ID - Type Unspecified