Provider Demographics
NPI:1306834585
Name:GARCIA, LUIS M JR (DPM FACFAS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:DPM FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-994-5956
Mailing Address - Fax:302-994-9638
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-994-5956
Practice Address - Fax:302-994-9638
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000080213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE578971Medicaid
DE159782Medicare PIN
DE578971Medicaid