Healthcare Provider Details

I. General information

NPI: 1255697041
Provider Name (Legal Business Name): DONALD RAYMOND GARRETT JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 E PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75082-3561
US

IV. Provider business mailing address

5246 BRITTANY DR
BATON ROUGE LA
70808-9136
US

V. Phone/Fax

Practice location:
  • Phone: 469-204-8000
  • Fax:
Mailing address:
  • Phone: 225-757-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ3187
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: