Provider Demographics
NPI:1750342309
Name:GARCIA, MARTIN A (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
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 1:836 PRUDENTIAL DR STE 1103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8338
Mailing Address - Country:US
Mailing Address - Phone:904-398-7654
Mailing Address - Fax:904-398-0118
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8338
Practice Address - Country:US
Practice Address - Phone:904-398-9499
Practice Address - Fax:904-398-0018
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41595207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257569800Medicaid
FL257569800Medicaid
FL15771WMedicare PIN