Provider Demographics
NPI:1245596832
Name:DEARING, GARRETT BLAZE (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:BLAZE
Last Name:DEARING
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 4130077 EAST MARSOC
Mailing Address - Street 2:1ST MARINE SPECIAL OPERATIONS BATALLION
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4130077 EAST MARSOC
Practice Address - Street 2:1ST MARINE SPECIAL OPERATIONS BATALLION
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5020
Practice Address - Country:US
Practice Address - Phone:760-725-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider