Provider Demographics
NPI:1649266297
Name:GARCIA, SERGIO G (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:G
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-515-4888
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:701 E ROBINSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6652
Practice Address - Country:US
Practice Address - Phone:405-515-4888
Practice Address - Fax:405-307-5620
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28909207P00000X, 207R00000X, 207RC0200X, 207RP1001X
MO167729207R00000X, 207RC0200X, 207RP1001X
MD2000167729207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
196690OtherBLUE CROSS BLUE SHIELD
MO208415422Medicaid
IL216097006Medicare PIN
196690OtherBLUE CROSS BLUE SHIELD
ORP00717202Medicare PIN
H07408Medicare UPIN
MO208415422Medicaid