Provider Demographics
NPI:1386858751
Name:GARCIA, LUIS JOSE (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JOSE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-5108
Mailing Address - Fax:319-356-3392
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-467-5108
Practice Address - Fax:319-356-3392
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA412032086S0127X, 208600000X, 2086S0102X
PAMT184333208600000X
MDD74581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055909100Medicaid
MD242988YVEMedicare PIN