MEDICARE: DIANA L GARRISON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA02587	TX

General Provider Information

NPI Number	:	1487870069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA L GARRISON PA-C

Provider Business Mailing Address
First Line	:	3801 GASTON AVE STE 302
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2532
Country	:	US
Telephone Number	:	214-828-0016
Fax Number	:	214-828-4883

Provider Business Practice Location Address
First Line	:	3801 GASTON AVE STE 302
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2532
Country	:	US
Telephone Number	:	214-828-0016
Fax Number	:	214-828-4883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/24/2009

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