Provider Demographics
NPI:1073046801
Name:GARCIA, EVAN-JACOB BEARINGER (MD)
Entity Type:Individual
Prefix:
First Name:EVAN-JACOB
Middle Name:BEARINGER
Last Name:GARCIA
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 WISHARD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4163
Practice Address - Country:US
Practice Address - Phone:317-944-3966
Practice Address - Fax:317-968-1354
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085280A170100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program