Healthcare Provider Details

I. General information

NPI: 1487734398
Provider Name (Legal Business Name): DERRICK L GARRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HOSPITAL DR
VICTORIA TX
77901-5748
US

IV. Provider business mailing address

1501 E MOCKINGBIRD LN STE 220
VICTORIA TX
77904-2139
US

V. Phone/Fax

Practice location:
  • Phone: 361-573-9181
  • Fax: 361-572-5126
Mailing address:
  • Phone: 913-234-1350
  • Fax: 913-234-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK2332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: