Provider Demographics
NPI:1770550196
Name:GARRED, JOHN L JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:GARRED
Suffix:JR
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 1:153 BLAIR ST
Mailing Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23466208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0208728Medicaid
NE42101479900Medicaid
010034591OtherRAILROAD MEDICARE
NE42101479900Medicaid
IAB18069Medicare UPIN