Healthcare Provider Details

I. General information

NPI: 1669692380
Provider Name (Legal Business Name): J. L. GARRED, SR., M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 BLAIR ST
WHITING IA
51063-1007
US

IV. Provider business mailing address

153 BLAIR ST PO BOX 289
WHITING IA
51063-1007
US

V. Phone/Fax

Practice location:
  • Phone: 712-455-2431
  • Fax: 712-455-2698
Mailing address:
  • Phone: 712-455-2431
  • Fax: 712-455-2698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN L GARRED SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 712-455-2431