Provider Demographics
NPI:1720051899
Name:PULIDO, JESUS GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:GARCIA
Last Name:PULIDO
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 1:6444 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2891
Mailing Address - Country:US
Mailing Address - Phone:904-805-9600
Mailing Address - Fax:904-805-0084
Practice Address - Street 1:6444 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2891
Practice Address - Country:US
Practice Address - Phone:904-805-9600
Practice Address - Fax:904-805-0084
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062480200Medicaid
FL74682OtherJCC GROUP ID#
FLE61988Medicare UPIN
FL07129AMedicare ID - Type Unspecified