Basic Information
| Provider Information | |||||||||
| NPI: | 1891987111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | KRISTIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 TULANE AVE # 8078 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049881236 | ||||||||
| FaxNumber: | 5049885483 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 TULANE AVE # 8078 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049881236 | ||||||||
| FaxNumber: | 5049885483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25216 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 19988 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 208000000X | 199988 | LA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 25216 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 199988 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10025121400 | 05 | NE | MEDICAID |