Provider Demographics
NPI:1033737580
Name:GARRETT, BRENDEN EUGENE
Entity Type:Individual
Prefix:
First Name:BRENDEN
Middle Name:EUGENE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 N 100 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6504
Mailing Address - Country:US
Mailing Address - Phone:801-960-8039
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9006
Practice Address - Country:US
Practice Address - Phone:214-648-3111
Practice Address - Fax:214-648-7517
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program