Provider Demographics
NPI:1922665892
Name:GARCIA, GLENN EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:RMC BAYONET POINT GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:14000 FIVAY ROAD
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-819-2966
Mailing Address - Fax:
Practice Address - Street 1:REGIONAL MEDICAL CENTER BAYONET POINT: GME
Practice Address - Street 2:14000 FIVAY ROAD
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-819-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-12-20
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME157133207R00000X, 208M00000X, 208D00000X
NJ390200000X
FLTRN31442390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME157133OtherFLORIDA BOARD OF MEDICINE