Provider Demographics
NPI:1720266265
Name:GARCIA, JOSEPH CASIMIR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CASIMIR
Last Name:GARCIA
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 1:23846 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6848
Mailing Address - Country:US
Mailing Address - Phone:253-372-7680
Mailing Address - Fax:
Practice Address - Street 1:23846 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6848
Practice Address - Country:US
Practice Address - Phone:253-372-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005849208000000X
WAMD60051084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8543423Medicaid
WAG8883852Medicare PIN
WAG8883851Medicare PIN