Organization
ST .CLAIR PEDAITRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY T GARRISON M.D. (OWNER)
(618) 624-9970
Entity
Organization
Contact information
Practice address
4941 BENCHMARK CENTRE DR, SUITE 100, SWANSEA, IL 62226-2038
(618) 624-9970
(618) 624-9973
Mailing address
4941 BENCHMARK CENTRE DR, SUITE 100, SWANSEA, IL 62226-2038
(618) 624-9970
(618) 624-9973
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08223014
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/15/2007
Last updated
08/15/2007
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