Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 8491 | TX |
Y | 213ER0200X | Radiology | 8491 | TX |
NPI | 1164539490 |
---|---|
Provider Name | Kenneth Dale Garrett |
First Address | Plano, TX 75075-8329 |
Second Address | Plano, TX 75075-8329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605282 | BCBS (01) | TX |