Healthcare Provider Details

I. General information

NPI: 1497856686
Provider Name (Legal Business Name): JEFFREY GARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 S BANNOCK ST
ENGLEWOOD CO
80110-5706
US

IV. Provider business mailing address

4548 S BANNOCK ST
ENGLEWOOD CO
80110-5706
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-1090
  • Fax:
Mailing address:
  • Phone: 303-929-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberAS0015
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAS0015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: