Provider Demographics
NPI:1265466403
Name:REGIMBAL, JOSEPH W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:REGIMBAL
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 1:11311 BRIDGEPORT WAY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-6688
Mailing Address - Fax:253-426-4142
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-6688
Practice Address - Fax:253-426-4142
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020157174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0274628OtherL&I
WAG8891633OtherMEDICARE
WA92155OtherDEPT. L & I
WA0262109OtherL&I
WA1002294Medicaid
WA1043485Medicaid
WAG8890783OtherMEDICARE
WAMD00020157OtherWA LICENSE
WA0261968OtherL&I
WAG8890784OtherMEDICARE
WAG8890784OtherMEDICARE
WAG8890784OtherMEDICARE