Provider Demographics
NPI:1154506780
Name:TAMBRA R GARRETT MD PA
Entity Type:Organization
Organization Name:TAMBRA R GARRETT MD PA
Other - Org Name:LIFESTYLE FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-539-5599
Mailing Address - Street 1:5870 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2282
Mailing Address - Country:US
Mailing Address - Phone:972-539-5599
Mailing Address - Fax:
Practice Address - Street 1:5870 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2282
Practice Address - Country:US
Practice Address - Phone:972-539-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017MNOtherBCBS
TX00920YMedicare PIN