Provider Demographics
NPI:1982982864
Name:GARCIA, WALLACY SOUZA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACY
Middle Name:SOUZA
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:3670 PARKER BLVD.
Practice Address - Street 2:STE 101
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2285
Practice Address - Country:US
Practice Address - Phone:719-564-1544
Practice Address - Fax:719-924-1592
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYP77521207RC0000X
CODR.0056470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease