Provider Demographics
NPI:1871589515
Name:GARRETT, HARRY TIMOTHY (DO)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:TIMOTHY
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2553
Mailing Address - Country:US
Mailing Address - Phone:618-395-7340
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:IL
Practice Address - Zip Code:62476-1202
Practice Address - Country:US
Practice Address - Phone:618-456-3727
Practice Address - Fax:618-456-3774
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068484Medicaid
IL1316984594OtherNPI
IL1215060298OtherNPI
IL1669514956OtherNPI
IL1215060298OtherNPI
722190Medicare ID - Type Unspecified
IL143900Medicare Oscar/Certification