Provider Demographics
NPI:1104961184
Name:GARCON, GREGOIRE (MD)
Entity type:Individual
Prefix:
First Name:GREGOIRE
Middle Name:
Last Name:GARCON
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 1:612 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1734
Mailing Address - Country:US
Mailing Address - Phone:954-535-1919
Mailing Address - Fax:954-973-3514
Practice Address - Street 1:612 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-1734
Practice Address - Country:US
Practice Address - Phone:954-535-1919
Practice Address - Fax:954-973-3514
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65394OtherBCBS
FL65394XMedicare PIN