Provider Demographics
NPI:1265489421
Name:GARRETT, DAVID C III (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:GARRETT
Suffix:III
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 1:613 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6611
Mailing Address - Country:US
Mailing Address - Phone:479-878-1060
Mailing Address - Fax:479-878-1070
Practice Address - Street 1:613 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6611
Practice Address - Country:US
Practice Address - Phone:479-878-1060
Practice Address - Fax:479-878-1070
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC68327Medicare UPIN
AR51834Medicare PIN
AR101168001Medicaid