Provider Demographics
NPI:1487734398
Name:GARRETT, DERRICK L (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN
Mailing Address - Street 2:STE 220
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2139
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5748
Practice Address - Country:US
Practice Address - Phone:361-573-9181
Practice Address - Fax:361-572-5126
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2332207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDK2332OtherWORKERS COMPENSATION
TX050069838OtherMEDICARE RAILROAD
TX87W157OtherBLUE CROSS
TX125633101Medicaid
87W157Medicare ID - Type Unspecified
TXMDK2332OtherWORKERS COMPENSATION