Basic Information
| Provider Information | |||||||||
| NPI: | 1265466403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REGIMBAL | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11311 BRIDGEPORT WAY SW STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539856688 | ||||||||
| FaxNumber: | 2534264142 | ||||||||
| Practice Location | |||||||||
| Address1: | 11311 BRIDGEPORT WAY SW STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539856688 | ||||||||
| FaxNumber: | 2534264142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00020157 | WA | N | Other Service Providers | Specialist | 207R00000X | MD00020157 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0274628 | 01 | WA | L&I | OTHER | G8891633 | 01 | WA | MEDICARE | OTHER | 92155 | 01 | WA | DEPT. L & I | OTHER | 0262109 | 01 | WA | L&I | OTHER | AR1369974 | 01 | WA | DEA | OTHER | 1002294 | 05 | WA | MEDICAID | 1043485 | 05 | WA | MEDICAID | G8890783 | 01 | WA | MEDICARE | OTHER | MD00020157 | 01 | WA | WA LICENSE | OTHER | 0261968 | 01 | WA | L&I | OTHER | G8890784 | 01 | WA | MEDICARE | OTHER |