Provider Demographics
NPI:1235126970
Name:GARRETT, MARY K (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W KALEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2931
Mailing Address - Country:US
Mailing Address - Phone:407-423-2581
Mailing Address - Fax:407-849-6470
Practice Address - Street 1:20 W KALEY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2931
Practice Address - Country:US
Practice Address - Phone:407-423-2581
Practice Address - Fax:407-849-6470
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME557122085P0229X
FLME 557122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0389765Medicaid
D33228Medicare UPIN
FL09744ZMedicare PIN