Provider Demographics
NPI:1760458608
Name:GARCES, DAGOBERTO J (MD)
Entity Type:Individual
Prefix:
First Name:DAGOBERTO
Middle Name:J
Last Name:GARCES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAGOBERTO
Other - Middle Name:J
Other - Last Name:GARCES-MILANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9785 SW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1435
Mailing Address - Country:US
Mailing Address - Phone:305-595-2629
Mailing Address - Fax:305-595-3606
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-324-8058
Practice Address - Fax:305-324-8035
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255490900Medicaid
FLE15834Medicare UPIN
FL92988AMedicare ID - Type Unspecified