Provider Demographics
NPI:1093770810
Name:GARRY, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:GARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CHURCH ST SE
Mailing Address - Street 2:CARDIOLOGY, MMC 508
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0215
Mailing Address - Country:US
Mailing Address - Phone:612-626-2178
Mailing Address - Fax:612-626-4571
Practice Address - Street 1:312 CHURCH ST SE
Practice Address - Street 2:CARDIOLOGY, MMC 508
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0215
Practice Address - Country:US
Practice Address - Phone:612-626-2178
Practice Address - Fax:612-626-4571
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7538207RC0000X
MN35034207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038834001Medicaid
F29016Medicare UPIN
TX8147J7Medicare ID - Type Unspecified