Provider Demographics
NPI:1669958799
Name:LARA GARCIA, ODALYS ESTEFANIA (MD)
Entity type:Individual
Prefix:DR
First Name:ODALYS
Middle Name:ESTEFANIA
Last Name:LARA GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:81 ED PERRY BLVD STE 107
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3465
Practice Address - Country:US
Practice Address - Phone:662-636-6290
Practice Address - Fax:662-636-1706
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125073171207R00000X
MS29119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine