Healthcare Provider Details

I. General information

NPI: 1669429213
Provider Name (Legal Business Name): MR. ALAN D GARRIGUS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC PSNS 1400 FARRAGU AVE
BREMERTON WA
98314-0001
US

IV. Provider business mailing address

25749 PYRAMID LN NW
POULSBO WA
98370-9471
US

V. Phone/Fax

Practice location:
  • Phone: 360-476-2572
  • Fax:
Mailing address:
  • Phone: 360-779-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: