Provider Demographics
NPI:1144726902
Name:CANNELL, GARRETT ANTHONY (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:ANTHONY
Last Name:CANNELL
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2201 CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:254-724-8572
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10063392207R00000X
TXT2570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine