Healthcare Provider Details

I. General information

NPI: 1235126970
Provider Name (Legal Business Name): MARY K GARRETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W KALEY ST
ORLANDO FL
32806-2931
US

IV. Provider business mailing address

20 W KALEY ST
ORLANDO FL
32806-2931
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-2581
  • Fax: 407-849-6470
Mailing address:
  • Phone: 407-423-2581
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME55712
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 55712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: