Healthcare Provider Details

I. General information

NPI: 1093861601
Provider Name (Legal Business Name): JOHN BRIAN GARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S NATIONAL AVE SUITE 400
SPRINGFIELD MO
65807-5209
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-2648
  • Fax: 417-875-3744
Mailing address:
  • Phone: 417-875-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2016016730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: