Provider Demographics
NPI:1518153618
Name:GARRETT L MARR, MD
Entity Type:Organization
Organization Name:GARRETT L MARR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-946-2208
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:SUITE B-3A BOX 460
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-946-2208
Mailing Address - Fax:480-946-2667
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:SUITE E-1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-946-2208
Practice Address - Fax:480-946-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ37030OtherAZ LICENSE