Provider Demographics
NPI:1184639445
Name:GARO, GLENN M (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:M
Last Name:GARO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 364
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5682
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:STE 2A, 2B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7263
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5683
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000046704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8456782Medicaid
WAG8873440Medicare PIN
WAI65076Medicare UPIN