Provider Demographics
NPI:1366583122
Name:GARRIGA, CARYN L (MD)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:L
Last Name:GARRIGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:249 CLARKSON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2219
Mailing Address - Country:US
Mailing Address - Phone:636-527-8900
Mailing Address - Fax:636-527-8912
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2219
Practice Address - Country:US
Practice Address - Phone:636-527-8900
Practice Address - Fax:636-527-8912
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003014162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207507807Medicaid