Provider Demographics
NPI:1194745984
Name:POOL, GARRETT M (MD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:M
Last Name:POOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WELCH ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1934
Mailing Address - Country:US
Mailing Address - Phone:503-874-0574
Mailing Address - Fax:035-874-0575
Practice Address - Street 1:450 WELCH ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1934
Practice Address - Country:US
Practice Address - Phone:503-874-0574
Practice Address - Fax:503-874-0575
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00856363AM0700X
390200000X
ORMD190722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program