Provider Demographics
NPI:1174555304
Name:DICK, GARRETT EVANS (WSC)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:EVANS
Last Name:DICK
Suffix:
Gender:M
Credentials:WSC
Other - Prefix:MR
Other - First Name:GRRETT
Other - Middle Name:EVANS
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MR
Mailing Address - Street 1:1378 SW BUCKSKIN TRL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7056
Mailing Address - Country:US
Mailing Address - Phone:772-349-1000
Mailing Address - Fax:772-781-1661
Practice Address - Street 1:1378 SW BUCKSKIN TRL
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7056
Practice Address - Country:US
Practice Address - Phone:772-349-1000
Practice Address - Fax:772-781-1661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management