Provider Demographics
NPI:1396724050
Name:GARCIA, JESUS RENE (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RENE
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 1:613 RUE DE ONETTA
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2164
Mailing Address - Country:US
Mailing Address - Phone:337-367-6776
Mailing Address - Fax:337-367-7330
Practice Address - Street 1:613 RUE DE ONETTA
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2164
Practice Address - Country:US
Practice Address - Phone:337-367-6776
Practice Address - Fax:337-367-7330
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09677R207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966479Medicaid
LA1966479Medicaid
5R647Medicare PIN