Provider Demographics
NPI:1578996468
Name:GARCIA SUERO, LUIS ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERNESTO
Last Name:GARCIA SUERO
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 1:17000 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:321-841-3467
Mailing Address - Fax:407-253-2563
Practice Address - Street 1:17000 PORTER RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:321-841-3467
Practice Address - Fax:407-253-2563
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51912207R00000X
FLME148616208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115380700Medicaid
FLUFMKFOtherFLORIDA BCBS