Provider Demographics
NPI:1255394235
Name:GARRETT, DALE G (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:G
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 1:1504 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1632
Mailing Address - Country:US
Mailing Address - Phone:785-270-8605
Mailing Address - Fax:785-270-8606
Practice Address - Street 1:1504 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1632
Practice Address - Country:US
Practice Address - Phone:785-270-8605
Practice Address - Fax:785-270-8606
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-310242083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002329OtherMEDICARE PTAN
KS200337260AMedicaid
067319Medicare ID - Type Unspecified
KS200337260AMedicaid