Healthcare Provider Details

I. General information

NPI: 1396183364
Provider Name (Legal Business Name): JEFF GARRETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP/SGST UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

35 MDG/SGXW UNIT 5024
APO AP
96319
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5321
  • Fax:
Mailing address:
  • Phone: 315-226-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018027033
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: