Provider Demographics
NPI:1497848725
Name:GARAN, JOHN JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GARAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4029
Mailing Address - Country:US
Mailing Address - Phone:304-723-2510
Mailing Address - Fax:304-723-2542
Practice Address - Street 1:3600 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4029
Practice Address - Country:US
Practice Address - Phone:304-723-2510
Practice Address - Fax:304-723-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVT32355Medicare UPIN
GA0533311Medicare ID - Type Unspecified