Provider Demographics
NPI:1477566966
Name:GARCIA, GERARDO E (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28370 COCO PALM DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-1112
Mailing Address - Country:US
Mailing Address - Phone:941-637-5833
Mailing Address - Fax:941-637-5833
Practice Address - Street 1:4054 BEAVER LN
Practice Address - Street 2:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52223OtherBCBS
FL52223XMedicare ID - Type Unspecified
FL52223WMedicare ID - Type Unspecified
FLI22512Medicare UPIN