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General NPI Number Information
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NPI Number | 1003781147
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Entity Type | Individual
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Provider Name | LARRY GARRISON PH.D., MBA, CCP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 8111 S EMERSON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8601
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Country | US
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Telephone | 317-528-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 6896 CARTERS GROVE DR
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City | NOBLESVILLE
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State | IN
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Zip | 46062-7969
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 242T00000X
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Taxonomy Name | Perfusionist
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License Number |
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License Number State |
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