Provider Demographics
NPI:1518270990
Name:GALVIN, MICHAEL P (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:GALVIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-7458
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:SUITE 500
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-251-5110
Practice Address - Fax:425-793-7382
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60131147363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical