Provider Demographics
NPI:1669692380
Name:J. L. GARRED, SR., M.D.P.C.
Entity type:Organization
Organization Name:J. L. GARRED, SR., M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARRED
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:712-455-2431
Mailing Address - Street 1:153 BLAIR ST
Mailing Address - Street 2:PO BOX 289
Mailing Address - City:WHITING
Mailing Address - State:IA
Mailing Address - Zip Code:51063-1007
Mailing Address - Country:US
Mailing Address - Phone:712-455-2431
Mailing Address - Fax:712-455-2698
Practice Address - Street 1:153 BLAIR ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IA
Practice Address - Zip Code:51063-1007
Practice Address - Country:US
Practice Address - Phone:712-455-2431
Practice Address - Fax:712-455-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP8181OtherRAILROAD MEDICARE
B18069Medicare UPIN
A14302Medicare UPIN
P40990Medicare UPIN
IAI7583Medicare PIN