Provider Demographics
NPI:1699933077
Name:MAYNARD E GARRETT MD APMC
Entity type:Organization
Organization Name:MAYNARD E GARRETT MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAYNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-847-1995
Mailing Address - Street 1:985 ROBERT BOULEVARD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-847-1995
Mailing Address - Fax:985-847-1992
Practice Address - Street 1:985 ROBERT BOULEVARD
Practice Address - Street 2:SUITE 104
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-847-1995
Practice Address - Fax:985-847-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA12053207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139572Medicaid
LA51004Medicare PIN
LA1139572Medicaid