MEDICARE: VIRGINIA L GARRISON MD

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	2085R0202X	Diagnostic Radiology Physician	24427	OK

General Provider Information

NPI Number	:	1558339911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA L GARRISON MD

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST
Second Line	:	ORI236
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 NE 13TH ST
Second Line	:	4G4250
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-5125
Fax Number	:	405-271-3462

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/26/2011

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