Provider Demographics
NPI:1982682779
Name:GARCIA, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
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 1:3417 TAMIAMI TRL STE G
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8158
Mailing Address - Country:US
Mailing Address - Phone:941-391-5522
Mailing Address - Fax:941-235-8946
Practice Address - Street 1:3417 TAMIAMI TRL STE G
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-391-5522
Practice Address - Fax:412-358-9469
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4596887OtherAETNA
09967OtherBLUE CROSS BLUE SHIELD
FL063225200Medicaid
110184271OtherRAILROAD MEDICARE
110184271OtherRAILROAD MEDICARE
E66916Medicare UPIN