Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0101044484 | VA |
NPI | 1013976216 |
---|---|
Provider Name | Dr. John R Garrett |
First Address | Arlington, VA 22205-3683 |
Second Address | Arlington, VA 22205-3683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C15955 | (02) | VA |