Provider Demographics
NPI:1669466629
Name:GARRETT, PATRICK F (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:GARRETT
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 1:12700 SOUTHFORK RD
Mailing Address - Street 2:STE. 280
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3201
Mailing Address - Country:US
Mailing Address - Phone:314-525-4990
Mailing Address - Fax:314-525-4926
Practice Address - Street 1:12700 SOUTHFORK RD
Practice Address - Street 2:STE. 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3201
Practice Address - Country:US
Practice Address - Phone:314-525-4990
Practice Address - Fax:314-525-4926
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1F53207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202466421Medicaid
MO202466421Medicaid
MO013013352Medicare ID - Type Unspecified