Healthcare Provider Details

I. General information

NPI: 1194745984
Provider Name (Legal Business Name): GARRETT M POOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 11TH ST STE M206
HERMISTON OR
97838-6941
US

IV. Provider business mailing address

620 NW 11TH ST STE M206
HERMISTON OR
97838-6941
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3804
  • Fax: 541-667-0192
Mailing address:
  • Phone: 541-667-3804
  • Fax: 541-667-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD190722
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00856
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: