Provider Demographics
NPI:1144397472
Name:GARRETT, DEIADRA (MD)
Entity type:Individual
Prefix:
First Name:DEIADRA
Middle Name:
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 1:4704 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6908
Mailing Address - Country:US
Mailing Address - Phone:337-470-5920
Mailing Address - Fax:337-371-3160
Practice Address - Street 1:4704 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6908
Practice Address - Country:US
Practice Address - Phone:337-470-5920
Practice Address - Fax:337-371-3160
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02974208000000X
LA023974208600000X, 2086S0102X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627123OtherBCBS PROVIDER ID
IL036114195 1Medicaid
I68776Medicare UPIN
ILK35373Medicare PIN