Provider Demographics
NPI:1962880039
Name:GARRISON, DAVID JEREMIAH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JEREMIAH
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 1:4231 BALBOA AVENUE
Mailing Address - Street 2:POB 1173
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:719-694-4321
Mailing Address - Fax:
Practice Address - Street 1:BANNER UNIVERSITY MEDICAL CENTER TUCSON
Practice Address - Street 2:1501 N. CAMPBELL AVE.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74952207P00000X
CAA167925207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine