Provider Demographics
NPI:1528279064
Name:GARRARD, JACQUELINE M (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:GARRARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-589-8028
Mailing Address - Fax:719-589-8086
Practice Address - Street 1:106 BLANCA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2340
Practice Address - Country:US
Practice Address - Phone:719-589-8028
Practice Address - Fax:719-589-8086
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37359207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1699757450OtherGROUP NPI
CO62557386Medicaid
CO62557386Medicaid
COC453168Medicare PIN
COCOAAA1406Medicare PIN