Provider Demographics
NPI:1033273461
Name:GARNETT, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-9237
Mailing Address - Country:US
Mailing Address - Phone:509-773-4017
Mailing Address - Fax:
Practice Address - Street 1:310 S ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9201
Practice Address - Country:US
Practice Address - Phone:509-773-4022
Practice Address - Fax:506-773-1941
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8278004Medicaid
WA115318802Medicare ID - Type UnspecifiedMEDICARE CLINIC
WA8278004Medicaid
WA000685401Medicare ID - Type Unspecified