Provider Demographics
NPI:1528159084
Name:GARRETT, COURTNEY W (MD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:W
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1605
Mailing Address - Country:US
Mailing Address - Phone:775-323-2157
Mailing Address - Fax:775-323-0749
Practice Address - Street 1:900 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1605
Practice Address - Country:US
Practice Address - Phone:775-323-2157
Practice Address - Fax:775-323-0749
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10882207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504133Medicaid
I11955Medicare UPIN
NV100504133Medicaid