Provider Demographics
NPI:1740261551
Name:LUIS M GARCIA, JR DPM
Entity type:Organization
Organization Name:LUIS M GARCIA, JR DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-994-5956
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-994-5956
Mailing Address - Fax:302-994-9638
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-994-5956
Practice Address - Fax:302-994-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989072683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000578917Medicaid
2177920000OtherKEYSTONE
DE=========OtherBLUE SHIELD
2177920000OtherKEYSTONE
849772Medicare ID - Type Unspecified
DE0466730001Medicare NSC