Provider Demographics
NPI:1083654347
Name:GARCIA, ALVARO IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:IVAN
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 1:601 N FLAMINGO RD STE 308
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1010
Mailing Address - Country:US
Mailing Address - Phone:954-369-5511
Mailing Address - Fax:954-323-5455
Practice Address - Street 1:601 N FLAMINGO RD STE 308
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1010
Practice Address - Country:US
Practice Address - Phone:954-369-5511
Practice Address - Fax:954-323-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279921900Medicaid
FLBCBS OF FLOther08702
TNCH3188OtherRAILROAD MEDICARE
TN4128546OtherBCBSTN
FLP00449659OtherRAILROAD MEDICARE
TNP00351153OtherRAILROAD MEDICARE
TN3283858Medicaid
TN3826074Medicaid
FL7913825OtherAETNA PROVIDER #
FL7913825OtherAETNA PROVIDER #
FL279921900Medicaid
TN3826074Medicaid