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NPI Code Detail

MEDICARE: MR. DOUGLAS C GARMAN ATC

MEDICARE: MR. DOUGLAS C GARMAN ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer36001042AIN

General Provider Information

NPI Number : 1508834805
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS C GARMAN ATC
Provider Business Mailing Address
First Line : 14711 DEERBERRY CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46814-9053
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5050 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 07/08/2007

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