Provider Demographics
NPI:1801881503
Name:GARRISON, MARK S (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:702 MANGROVE AVE
Mailing Address - Street 2:PMB 313
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3948
Mailing Address - Country:US
Mailing Address - Phone:530-566-0132
Mailing Address - Fax:530-566-1682
Practice Address - Street 1:1025 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2812
Practice Address - Country:US
Practice Address - Phone:530-566-0132
Practice Address - Fax:530-566-1682
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9268207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
160035735OtherRAILROAD MEDICARE
CA20A9268OtherCALIF LICENSE
CA00AX92680Medicaid
CA00AX92680Medicaid
E51854Medicare UPIN