Provider Demographics
NPI:1669583977
Name:GARRETT, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD
Practice Address - Street 2:#215
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7901
Practice Address - Country:US
Practice Address - Phone:916-691-5900
Practice Address - Fax:916-691-6747
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA69712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697120Medicaid
00A697120Medicare ID - Type Unspecified
H40760Medicare UPIN