Provider Demographics
NPI:1225241177
Name:GALAVIZ, MANUEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:R
Last Name:GALAVIZ
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 1:15712 NE 28TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1533
Mailing Address - Country:US
Mailing Address - Phone:360-574-7946
Mailing Address - Fax:
Practice Address - Street 1:1706 W MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4320
Practice Address - Country:US
Practice Address - Phone:360-666-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019433207Q00000X
ORMD13449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAC92048Medicare UPIN