Healthcare Provider Details

I. General information

NPI: 1548884364
Provider Name (Legal Business Name): GARREN DIAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WIREGRASS RANCH BLVD
WESLEY CHAPEL FL
33543-4274
US

IV. Provider business mailing address

3000 WIREGRASS RANCH BLVD
WESLEY CHAPEL FL
33543-4274
US

V. Phone/Fax

Practice location:
  • Phone: 407-712-8131
  • Fax: 321-843-2196
Mailing address:
  • Phone: 407-712-8131
  • Fax: 321-843-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: