Basic Information
| Provider Information | |||||||||
| NPI: | 1902284870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRISON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5575 SIMMONS ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890319008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023042144 | ||||||||
| FaxNumber: | 7023042147 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023884000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2015 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E-11836 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | SL1077 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO2406 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.