Provider Demographics
NPI:1477629004
Name:GARCIA, JUAN A (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
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 1:3000 MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4696
Mailing Address - Country:US
Mailing Address - Phone:813-497-9661
Mailing Address - Fax:813-615-8468
Practice Address - Street 1:3000 MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4696
Practice Address - Country:US
Practice Address - Phone:813-497-9661
Practice Address - Fax:813-615-8468
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39765207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060009579OtherRAILROAD MEDICARE
FL00656OtherUNIVERSAL
FL592998397COtherHUMANA
FL211526OtherAUMED
FL069495900Medicaid
FL4045526OtherAETNA
FL211526OtherAUMED
FL4045526OtherAETNA