Healthcare Provider Details

I. General information

NPI: 1245762608
Provider Name (Legal Business Name): BRENT GARRISON OXFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ABRAHAM FLEXNER WAY FL 15
LOUISVILLE KY
40202-3826
US

IV. Provider business mailing address

220 ABRAHAM FLEXNER WAY FL 15
LOUISVILLE KY
40202-3826
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-2160
  • Fax:
Mailing address:
  • Phone: 502-588-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR5162
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: