Provider Demographics
NPI:1669552626
Name:GARCIA, ROBERTO ELOY (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ELOY
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 1:230 A1A N
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1709
Mailing Address - Country:US
Mailing Address - Phone:904-686-8020
Mailing Address - Fax:904-834-2592
Practice Address - Street 1:230 A1A N
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1709
Practice Address - Country:US
Practice Address - Phone:904-686-8020
Practice Address - Fax:904-834-2592
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME866992082S0099X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6245YOtherMEDICARE PTAN
9406570OtherPHCS
2998006OtherCIGNA
FLU6245YOtherMEDICARE PTAN
FL16184OtherBCBS
FLI45197Medicare UPIN
7390708OtherAETNA