Healthcare Provider Details

I. General information

NPI: 1790809168
Provider Name (Legal Business Name): BYRON JAMES GARN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

1920 E CAMBRIDGE AVE
PHOENIX AZ
85006-1459
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-6000
  • Fax:
Mailing address:
  • Phone: 602-253-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301085419
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301085419
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301085419
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number42040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: