Healthcare Provider Details

I. General information

NPI: 1447523709
Provider Name (Legal Business Name): BRUCE NEIL GARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 24TH ST NW SUITE 17
WASHINGTON DC
20037-2543
US

IV. Provider business mailing address

730 24TH ST NW SUITE 17
WASHINGTON DC
20037-2543
US

V. Phone/Fax

Practice location:
  • Phone: 202-337-7660
  • Fax:
Mailing address:
  • Phone: 202-337-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number11894
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: