Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101031834 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101031834 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD464996 | PA |
NPI | 1396770665 |
---|---|
Provider Name | Dr. Algin Baylor Garrett |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Glen Allen, VA 23059-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5940290 | (05) | VA |
D71236 | (02) | VA |