Provider Demographics
NPI:1265412613
Name:GARRETT, DAVID DEAN (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 B ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6808
Mailing Address - Country:US
Mailing Address - Phone:918-542-5551
Mailing Address - Fax:918-542-1555
Practice Address - Street 1:30 B ST SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6808
Practice Address - Country:US
Practice Address - Phone:918-542-5551
Practice Address - Fax:918-542-1555
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100780720AMedicaid
OK100724930AMedicaid
OK100724930BMedicaid
OK100724930CMedicaid
OK100724930GMedicaid
OK4754060001Medicare NSC
OKP00030859Medicare PIN
OK100724930GMedicaid
OK100724930AMedicaid
OK200522011Medicare PIN
U83176Medicare UPIN
OK100724930CMedicaid
OK4754060002Medicare NSC