Provider Demographics
NPI:1235173139
Name:GARMENDIA, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:GARMENDIA
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 1:2636 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4056
Mailing Address - Country:US
Mailing Address - Phone:904-384-5553
Mailing Address - Fax:904-384-2173
Practice Address - Street 1:2636 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4056
Practice Address - Country:US
Practice Address - Phone:904-384-5553
Practice Address - Fax:904-384-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110024191OtherRAILROAD MEDICARE
GA000516689AMedicaid
FL052375500Medicaid
110024191OtherRAILROAD MEDICARE
GA000516689AMedicaid