Provider Demographics
NPI:1932158581
Name:GARRETT, GARY D (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 I 30
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6905
Mailing Address - Country:US
Mailing Address - Phone:469-800-2800
Mailing Address - Fax:469-800-2801
Practice Address - Street 1:1575 I 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6905
Practice Address - Country:US
Practice Address - Phone:469-800-2800
Practice Address - Fax:469-800-2801
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0450348-01Medicaid
TX86106GOtherBCBS
TX080126569OtherRR MEDICARE
TX86892JMedicare PIN
TX86106GOtherBCBS