Healthcare Provider Details

I. General information

NPI: 1417959644
Provider Name (Legal Business Name): JAMES R. L. GARB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 OLD HIGHWAY 63 S SUITE 200
COLUMBIA MO
65201-6092
US

IV. Provider business mailing address

1316 OLD HIGHWAY 63 S SUITE 200
COLUMBIA MO
65201-6092
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-4272
  • Fax: 573-815-2477
Mailing address:
  • Phone: 573-445-4272
  • Fax: 573-815-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8373
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: