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General NPI Number Information
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NPI Number | 1730701269
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Entity Type | Individual
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Provider Name | GARRET HISLE MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 1 BAYLOR PLZ
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City | HOUSTON
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State | TX
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Zip | 77030-3498
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Country | US
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Telephone | 713-798-5828
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 S 31ST ST # MS -35300
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City | TEMPLE
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State | TX
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Zip | 76508-0001
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Country | US
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Telephone | 254-724-5455
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Fax | 254-724-0764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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