Provider Demographics
NPI:1518943158
Name:GARNETT, MARK HAMILTON (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAMILTON
Last Name:GARNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPEARMAN
Mailing Address - State:TX
Mailing Address - Zip Code:79081-3442
Mailing Address - Country:US
Mailing Address - Phone:806-659-1778
Mailing Address - Fax:806-659-1027
Practice Address - Street 1:712 ROLAND ST
Practice Address - Street 2:
Practice Address - City:SPEARMAN
Practice Address - State:TX
Practice Address - Zip Code:79081-3442
Practice Address - Country:US
Practice Address - Phone:806-659-1778
Practice Address - Fax:806-659-1027
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097HUOtherBLUE CROSS BLUE SHIELD
TX1471765-01Medicaid
TX1471765-01Medicaid
TX00610QMedicare Oscar/Certification