Healthcare Provider Details

I. General information

NPI: 1598757510
Provider Name (Legal Business Name): JAMES GARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N WEIGLE AVE
WATONGA OK
73772-3840
US

IV. Provider business mailing address

203 N WEIGLE AVE PO BOX 60
WATONGA OK
73772-3840
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-2233
  • Fax: 580-623-2232
Mailing address:
  • Phone: 580-623-2233
  • Fax: 580-623-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23092
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: