Provider Demographics
NPI:1285980094
Name:GARR, RANDY (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:GARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1355 N UNIVERSITY AVE
Mailing Address - Street 2:STE 125
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2721
Mailing Address - Country:US
Mailing Address - Phone:801-374-3010
Mailing Address - Fax:801-377-2426
Practice Address - Street 1:1355 N UNIVERSITY AVE
Practice Address - Street 2:STE 125
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2721
Practice Address - Country:US
Practice Address - Phone:801-374-3010
Practice Address - Fax:801-377-2426
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9293096-0501213ES0103X
WAPODL.PL.60302986213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery