Provider Demographics
NPI:1710930094
Name:GARNIC, JOSEPH DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:GARNIC
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 1:401 15TH AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-0484
Mailing Address - Fax:406-453-9504
Practice Address - Street 1:401 15TH AVE S STE 204
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-0484
Practice Address - Fax:406-453-9504
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG519062085R0202X
MT115772085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091468OtherBCBS
CA00G519060Medicaid
CA00G519060OtherBLUE SHIELD
CAWG51906JMedicare PIN
MT000091468OtherBCBS
A52117Medicare UPIN