Provider Demographics
NPI:1912032822
Name:GARRIQUES, IAN LLOYD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:LLOYD
Last Name:GARRIQUES
Suffix:JR
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 1:496 ALTAPASS HWY
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-3011
Mailing Address - Country:US
Mailing Address - Phone:828-765-0170
Mailing Address - Fax:828-765-5877
Practice Address - Street 1:496 ALTAPASS HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3011
Practice Address - Country:US
Practice Address - Phone:828-765-0170
Practice Address - Fax:828-765-5877
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0021275207R00000X
NC2006-00656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52928OtherBLUE CROSS, BLUE SHIELD
NC2071062OtherMEDICARE PTAN
NC2071062OtherMEDICARE PTAN
FLD85975Medicare UPIN