Provider Demographics
NPI:1104850692
Name:GARCIA, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 262186
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-2186
Mailing Address - Country:US
Mailing Address - Phone:813-926-4058
Mailing Address - Fax:813-926-9872
Practice Address - Street 1:10940 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:813-926-4058
Practice Address - Fax:813-926-9872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46917207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263128800Medicaid
FL30869OtherBLUE CROSS BLUE SHIELD
FL38518OtherBLUE CROSS GROUP
FL083117OtherAVMED
FL261980600Medicaid
FL1727572OtherCIGNA
FL2051099OtherAETNA
FL59-3541427OtherTAX IDENTIFICATION
FL030004077Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL38518OtherBLUE CROSS GROUP
FL1727572OtherCIGNA