Provider Demographics
NPI:1639265846
Name:GARCIA, RUBEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:R
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 1:411 E NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-7444
Mailing Address - Country:US
Mailing Address - Phone:850-892-4791
Mailing Address - Fax:850-782-3868
Practice Address - Street 1:411 E NELSON AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7444
Practice Address - Country:US
Practice Address - Phone:850-892-4791
Practice Address - Fax:850-782-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59559208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660200200Medicaid
FL052715700Medicaid
FL660200201Medicaid
FLME59559OtherCOMMERCIAL INS
FL660200200Medicaid
FLE19933Medicare UPIN
FL11921Medicare ID - Type Unspecified