Provider Demographics
NPI:1447387295
Name:GERARDO E GARCIA MD LLC
Entity Type:Organization
Organization Name:GERARDO E GARCIA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-613-6850
Mailing Address - Street 1:4054 BEAVER LN
Mailing Address - Street 2:SUTIE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9296
Mailing Address - Country:US
Mailing Address - Phone:941-613-6850
Mailing Address - Fax:941-613-6851
Practice Address - Street 1:4054 BEAVER LN
Practice Address - Street 2:SUTIE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9296
Practice Address - Country:US
Practice Address - Phone:941-613-6850
Practice Address - Fax:941-613-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22512Medicare UPIN
FLAC076Medicare PIN