Provider Demographics
NPI:1508870049
Name:GARBO, JOSEPH PHILLIP (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILLIP
Last Name:GARBO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 NORTH JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601
Mailing Address - Country:US
Mailing Address - Phone:601-833-4815
Mailing Address - Fax:601-833-4871
Practice Address - Street 1:427 NORTH JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-4815
Practice Address - Fax:601-833-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80155213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120271Medicaid
480026817OtherMCRR
MS00120271Medicaid
480026817OtherMCRR