Basic Information
| Provider Information | |||||||||
| NPI: | 1538111836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARVIN | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | JEFFREY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9621 RIDGETOP BLVD NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9398 RIDGETOP BLVD NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823222 | ||||||||
| FaxNumber: | 3607823245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD00029847 | WA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 4038840 | 01 | AETNA | OTHER | 340006217 | 01 | RAILROAD MEDICARE | OTHER | 78764 | 01 | WA | LABOR & INDUSTRIES | OTHER | GA9641 | 01 | REGENCE BLUE SHIELD | OTHER | 8139636 | 05 | WA | MEDICAID |