Healthcare Provider Details

I. General information

NPI: 1063463602
Provider Name (Legal Business Name): JAMES R GARNER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 15TH ST
WOODWARD OK
73801-3008
US

IV. Provider business mailing address

1000 15TH ST
WOODWARD OK
73801-3008
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-2820
  • Fax: 580-256-2454
Mailing address:
  • Phone: 580-256-2820
  • Fax: 580-256-2454

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: JAMES R GARNER
Title or Position: PRESIDENT
Credential: MD
Phone: 580-256-2820