Provider Demographics
NPI:1710170261
Name:GARRETT, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
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 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-496-2600
Mailing Address - Fax:937-496-2610
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:937-496-2610
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094631207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062901Medicaid
OH0062901Medicaid