Provider Demographics
NPI:1497034912
Name:JM GARMENDIA MD PA
Entity Type:Organization
Organization Name:JM GARMENDIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GARMENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:904-384-5553
Mailing Address - Street 1:2636 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4506
Mailing Address - Country:US
Mailing Address - Phone:904-384-5553
Mailing Address - Fax:904-384-2173
Practice Address - Street 1:2636 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4506
Practice Address - Country:US
Practice Address - Phone:904-384-5553
Practice Address - Fax:904-384-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000516689AMedicaid
FL052375500Medicaid
FL052375500Medicaid
GA000516689AMedicaid