Provider Demographics
NPI:1427273895
Name:DE CASTRO, GARRET G (MD)
Entity type:Individual
Prefix:
First Name:GARRET
Middle Name:G
Last Name:DE CASTRO
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 1:606 OAKESDALE AVE SW STE C200
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5227
Mailing Address - Country:US
Mailing Address - Phone:866-259-1629
Mailing Address - Fax:
Practice Address - Street 1:606 OAKESDALE AVE SW STE C200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:866-259-1629
Practice Address - Fax:855-666-8541
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1427273895Medicaid
WAG8902741Medicare PIN
WAP00991260OtherRR MEDICARE
WA0284411OtherL&I