Basic Information
| Provider Information | |||||||||
| NPI: | 1669692380 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | J. L. GARRED, SR., M.D.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 153 BLAIR ST | ||||||||
| Address2: | PO BOX 289 | ||||||||
| City: | WHITING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510631007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124552431 | ||||||||
| FaxNumber: | 7124552698 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 BLAIR ST | ||||||||
| Address2: | |||||||||
| City: | WHITING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510631007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124552431 | ||||||||
| FaxNumber: | 7124552698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | GARRED | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7124552431 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CP8181 | 01 | RAILROAD MEDICARE | OTHER |