Provider Demographics
NPI:1780677609
Name:GARGES, LAWRENCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:GARGES
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 1:1207 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2843
Mailing Address - Country:US
Mailing Address - Phone:509-751-0600
Mailing Address - Fax:509-751-8863
Practice Address - Street 1:1207 EVERGREEN CT
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2843
Practice Address - Country:US
Practice Address - Phone:509-751-0600
Practice Address - Fax:509-751-8863
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011322207K00000X, 207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1272004Medicaid
ID805721200Medicaid
030004799OtherRR MEDICARE
WA1272004Medicaid
ID805721200Medicaid