Provider Demographics
NPI:1043218449
Name:GARBER, VERNON L (DPM)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:GARBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 DR. MICHAEL DEBAKEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5726
Mailing Address - Country:US
Mailing Address - Phone:337-433-3338
Mailing Address - Fax:337-433-3337
Practice Address - Street 1:651 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5726
Practice Address - Country:US
Practice Address - Phone:337-433-3338
Practice Address - Fax:337-433-3337
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD142R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER
LA5U822Medicare PIN