Provider Demographics
NPI:1811994726
Name:GARBACIAK, JOHN A JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:GARBACIAK
Suffix:JR
Gender:
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:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:10214 N TATUM BLVD STE A600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4247
Practice Address - Country:US
Practice Address - Phone:602-406-1530
Practice Address - Fax:602-406-1539
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2025-05-08
Deactivation Date:2006-03-30
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
AZ16839207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ16WCLDF02Medicare ID - Type Unspecified
AZA15939Medicare UPIN