Healthcare Provider Details

I. General information

NPI: 1598806663
Provider Name (Legal Business Name): PATRICK MICHAEL GARRISON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1253
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE 140
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-7009
  • Fax: 405-330-1811
Mailing address:
  • Phone: 405-752-3162
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23948
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23948
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: