Healthcare Provider Details

I. General information

NPI: 1871171025
Provider Name (Legal Business Name): IAN GARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP, JBSA LACKLAND AFB, TX 78236
APO AA
78236
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP, JBSA LACKLAND AFB, TX 78236
APO AA
78236
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-2907
  • Fax:
Mailing address:
  • Phone: 210-292-6255
  • Fax: 210-292-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number45359
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: