Provider Demographics
NPI:1528111598
Name:GARRETT, WAYNE LEE (DO)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEE
Last Name:GARRETT
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 1:96 MUSEUM WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1428
Mailing Address - Country:US
Mailing Address - Phone:510-662-5200
Mailing Address - Fax:510-662-5240
Practice Address - Street 1:712 ALFRED NOBEL DR
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1805
Practice Address - Country:US
Practice Address - Phone:510-662-5200
Practice Address - Fax:510-662-5240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5450207ZP0101X
PAOS008397L207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14536Medicare UPIN