=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770553828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL DIMITRE GARST M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MEDICAL DIRECTOR, TRICARE REGIONAL OFFICE NORTH 1700 N. MOORE ST., SUITE 1200
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-588-1831
-----------------------------------------------------
Fax | 703-696-5216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6223 LEE HWY
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22205-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-532-8988
-----------------------------------------------------
Fax | 703-532-8999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G48697
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------