MEDICARE: LAWRENCE M. GARGES, MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD00011322	WA
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	MD00011322	WA
3	207K00000X	Allergy & Immunology Physician	MD00011322	WA

General Provider Information

NPI Number	:	1497006704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE M. GARGES, MD, PLLC

Provider Business Mailing Address
First Line	:	1207 EVERGREEN CT
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2843
Country	:	US
Telephone Number	:	509-751-0600
Fax Number	:	509-751-8863

Provider Business Practice Location Address
First Line	:	1207 EVERGREEN CT
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2843
Country	:	US
Telephone Number	:	509-751-0600
Fax Number	:	509-751-8863

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAWRENCE M GARGES
Credential	:	MD,, PLLC
Telephone Number	:	509-751-0600

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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