Provider Demographics
NPI:1063496958
Name:PANLASIGUI, LEONICO GARCIA (MD)
Entity type:Individual
Prefix:DR
First Name:LEONICO
Middle Name:GARCIA
Last Name:PANLASIGUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1911 SW CAMPUS DR
Mailing Address - Street 2:STE 440
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6473
Mailing Address - Country:US
Mailing Address - Phone:253-874-9430
Mailing Address - Fax:253-924-1548
Practice Address - Street 1:34616 11TH PL S
Practice Address - Street 2:SUITE # 6
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-874-9430
Practice Address - Fax:253-924-1548
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00021383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112671Medicaid
WAE53905Medicare UPIN
WA1112671Medicaid