Provider Demographics
NPI:1285645630
Name:GARCIA, JOSE Y JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:Y
Last Name:GARCIA
Suffix:JR
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 1:1221 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2829
Mailing Address - Country:US
Mailing Address - Phone:509-758-5511
Mailing Address - Fax:509-757-9406
Practice Address - Street 1:1119 HIGHLAND AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2836
Practice Address - Country:US
Practice Address - Phone:509-751-0312
Practice Address - Fax:509-751-0314
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039189207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B1824OtherBLUE CROSS OF IDAHO
ID806593400Medicaid
000010142734OtherREGENCE BLUE SHIELD OF IDAHO
WA8323073Medicaid
000010142734OtherREGENCE BLUE SHIELD OF IDAHO
ID806593400Medicaid
WAAB34350Medicare PIN