Provider Demographics
NPI:1538111836
Name:GARVIN, TODD JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JEFFREY
Last Name:GARVIN
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3200
Mailing Address - Fax:
Practice Address - Street 1:9398 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8505
Practice Address - Country:US
Practice Address - Phone:360-782-3222
Practice Address - Fax:360-782-3245
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029847208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4038840OtherAETNA
340006217OtherRAILROAD MEDICARE
WA78764OtherLABOR & INDUSTRIES
GA9641OtherREGENCE BLUE SHIELD
WA8139636Medicaid
WAG115136416Medicare PIN
WAG000250414Medicare PIN
A12386Medicare UPIN
340006217OtherRAILROAD MEDICARE
WA8139636Medicaid
WAG000250624Medicare PIN
WA78764OtherLABOR & INDUSTRIES
WAG000250709Medicare PIN