Provider Demographics
NPI:1124376389
Name:WOBST, GARRETT MANFRED (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:MANFRED
Last Name:WOBST
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 1:701 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1865
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:605-225-0351
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1865
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-225-0351
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3554213ES0103X
PASC006440213ES0103X
SD223213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO 3554OtherFLORIDA LIC
PASC006440OtherPA