Provider Demographics
NPI:1710928700
Name:GARCIA, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
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 1:2214 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-680-7618
Practice Address - Street 1:695 N KELLOGG ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2807
Practice Address - Country:US
Practice Address - Phone:309-343-7195
Practice Address - Fax:309-345-4289
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107806207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36107806OtherBCBS
ILIL01X6OtherJOHN DEERE
IL7215059OtherBCBS PPO
ILP00392078OtherRAILROAD MCARE PTAN
IL0361078063Medicaid
IL0361078063Medicaid
ILK34565Medicare PIN
ILK34565Medicare PIN