Individual
GARRETT H BASTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10101 ERNST RD STE 1200, ROANOKE, IN 46783-9711
(260) 234-5400
(260) 234-5410
Mailing address
750 BROADWAY STE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02006843A
IN
207Q00000X
Family Medicine Physician
11021719A
IN
Other
Enumeration date
06/10/2021
Last updated
09/26/2024
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