Provider Demographics
NPI:1093832974
Name:GARCIA, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-3430
Mailing Address - Fax:
Practice Address - Street 1:1810 ELDRON BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909
Practice Address - Country:US
Practice Address - Phone:321-434-3430
Practice Address - Fax:321-434-3432
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108653207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003094400Medicaid
FLEL702YOtherMEDICARE
FLP01273257OtherRRMR
WAG8874070Medicare PIN
FL003094400Medicaid
WA0236971OtherLABOR & INDUSTRIES
P00712160OtherRAILROAD MEDICARE