Provider Demographics
NPI:1922105600
Name:GARCIA, JUAN PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PHILLIP
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:FELIPE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 3RD STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266
Mailing Address - Country:US
Mailing Address - Phone:904-247-8522
Mailing Address - Fax:904-247-9722
Practice Address - Street 1:700 3RD STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266
Practice Address - Country:US
Practice Address - Phone:904-247-8522
Practice Address - Fax:904-247-9722
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME776322082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
593748055OtherCIGNA
FL51049OtherBCBS
7644306OtherAETNA
280557OtherAVMED
593748055OtherBEECHSTREET
593748055OtherTRICARE
593748055OtherHUMANA
9410441OtherPHCS
9410441OtherPHCS
593748055OtherTRICARE