Provider Demographics
NPI:1437215886
Name:GARREN, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GARREN
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 1:1 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1948
Mailing Address - Country:US
Mailing Address - Phone:617-820-8989
Mailing Address - Fax:972-820-1020
Practice Address - Street 1:6957 W PLANO PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1621
Practice Address - Country:US
Practice Address - Phone:918-579-8200
Practice Address - Fax:918-579-8204
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2172542085R0001X
OK289692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2008670Medicaid
MA110033817AMedicaid
MAA35409Medicare PIN
MAH92153Medicare UPIN
OKOKA104316Medicare PIN
MAP00054925Medicare PIN