Provider Demographics
NPI:1427133644
Name:DOUGLAS GARRISON, DO
Entity type:Organization
Organization Name:DOUGLAS GARRISON, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO, CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-566-0132
Mailing Address - Street 1:1025 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2812
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX62920Medicaid
DD4269OtherMEDICARE RAILROAD GROUP #
DD4269OtherMEDICARE RAILROAD GROUP #
CAZZZ02226ZMedicare PIN