MEDICARE: G BOLAR GARRISON MD INC

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	207L00000X	Anesthesiology Physician	7000	OK

General Provider Information

NPI Number	:	1972689149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G BOLAR GARRISON MD INC

Provider Business Mailing Address
First Line	:	3617 NW 65 ST
Second Line	:
City	:	OKLA CITY
State	:	OK
Zip	:	73116-2005
Country	:	US
Telephone Number	:	405-842-3402
Fax Number	:	405-879-9879

Provider Business Practice Location Address
First Line	:	3617 NW 65 ST
Second Line	:
City	:	OKLA CITY
State	:	OK
Zip	:	73116-2005
Country	:	US
Telephone Number	:	405-842-3402
Fax Number	:	405-879-9879

Authorized Official
Title or Position	:	PRES
Name	:	G BOLAR GARRISON
Credential	:	MD
Telephone Number	:	405-842-3402

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/22/2020

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