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Individual
DEIADRA GARRETT
Active
Individual
DEIADRA GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
02974
LA
208600000X
Surgery Physician
023974
LA
2086S0102X
Surgical Critical Care Physician
023974
LA
2086S0120X
Pediatric Surgery Physician
Primary
023974
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114195 1
—
IL
01
—
1627123
BCBS PROVIDER ID
IL
Enumeration date
11/30/2006
Last updated
01/21/2022
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