Provider Demographics
NPI:1275529471
Name:GARZON, MYRIAM P (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:P
Last Name:GARZON
Suffix:
Gender:F
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:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-898-3997
Practice Address - Street 1:1517 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2121
Practice Address - Country:US
Practice Address - Phone:407-648-9500
Practice Address - Fax:407-898-3997
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64290207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23589OtherBCBS
FL374969000Medicaid
FLF70136Medicare UPIN
FL23589YMedicare PIN