Healthcare Provider Details

I. General information

NPI: 1710981659
Provider Name (Legal Business Name): GEOFFREY W GARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 ASHLEY RIDGE BLVD
SHREVEPORT LA
71106-7229
US

IV. Provider business mailing address

471 ASHLEY RIDGE BLVD
SHREVEPORT LA
71106-7229
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-4770
  • Fax: 318-795-4775
Mailing address:
  • Phone: 318-795-4770
  • Fax: 318-795-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number06311R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: