Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 202974 | MA |
NPI | 1295841138 |
---|---|
Provider Name | Steven J Garrett |
First Address | Mashpee, MA 02649 |
Second Address | Mashpee, MA 02649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A31101 | PTAN (01) | MA |