Healthcare Provider Details

I. General information

NPI: 1265412613
Provider Name (Legal Business Name): DAVID DEAN GARRETT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 B ST SW
MIAMI OK
74354-6808
US

IV. Provider business mailing address

30 B ST SW
MIAMI OK
74354-6808
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-5551
  • Fax: 918-542-1555
Mailing address:
  • Phone: 918-542-5551
  • Fax: 918-542-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number228
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: