Provider Demographics
NPI:1609835883
Name:GARCIA-RIOS, JOSE LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LEON
Last Name:GARCIA-RIOS
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 1:217 GOVERNMENT AVE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1875
Mailing Address - Country:US
Mailing Address - Phone:850-678-4220
Mailing Address - Fax:850-678-4919
Practice Address - Street 1:217 GOVERNMENT AVE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1806
Practice Address - Country:US
Practice Address - Phone:850-678-4220
Practice Address - Fax:850-678-4919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21273207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62471Medicare UPIN
FL46088Medicare ID - Type Unspecified