Provider Demographics
NPI:1306822762
Name:OLINDE, JOHN GARNIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARNIER
Last Name:OLINDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:95 BULLDOG BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3332
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE 2D
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-724-1084
Practice Address - Fax:321-724-0147
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82820208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5101992003OtherCIGNA
FL262277700Medicaid
FL5902656OtherAETNA
FL01105OtherBLUE CROSS BLUE SHIELD
FL2599706OtherAETNA
FLP00088729OtherRAILROAD MEDICARE
FL226202OtherWELLCARE
FLP00088729OtherRAILROAD MEDICARE
FL262277700Medicaid