Provider Demographics
NPI:1225023088
Name:GARR, ROBERT JACKSON (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JACKSON
Last Name:GARR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:435-841-7095
Mailing Address - Fax:
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 320
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-716-2200
Practice Address - Fax:435-716-2220
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4761224-1204207RC0000X
IL036-111936207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1225023088Medicaid
UT1225023088Medicaid
UT000061383Medicare PIN