Provider Demographics
NPI:1477648293
Name:GARCIA, JOSE E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:GARCIA
Suffix:JR
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 1:11255 SW 211TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2240
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:786-235-0145
Practice Address - Street 1:11255 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2240
Practice Address - Country:US
Practice Address - Phone:305-254-7576
Practice Address - Fax:305-252-9528
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-53888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062267200Medicaid
FLBG1567467OtherDEA REGISTRATION
FLE60438Medicare UPIN
FL062267200Medicaid