Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 02974 | LA |
N | 208200000X | Surgeon | 023974 | LA |
N | 208600000X | Surgeon | 023974 | LA |
N | 2086S0102X | Surgical Critical Care | 023974 | LA |
Y | 2086S0120X | Pediatric Surgery | 023974 | LA |
NPI | 1144397472 |
---|---|
Provider Name | Deiadra Garrett |
First Address | Lafayette, LA 70508-6908 |
Second Address | Lafayette, LA 70508-6908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 21/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036114195 1 | (05) | IL |
1627123 | BCBS PROVIDER ID (01) | IL |