Provider Demographics
NPI:1215088372
Name:GARCIA, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
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 1:3165 N MCMULLEN BOOTH RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2032
Mailing Address - Country:US
Mailing Address - Phone:727-392-6849
Mailing Address - Fax:
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD
Practice Address - Street 2:BUILDING B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2032
Practice Address - Country:US
Practice Address - Phone:727-799-9060
Practice Address - Fax:727-799-5315
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62582OtherBCBSF PROVIDER NUMBER
FLE31878Medicare UPIN
FL62582OtherBCBSF PROVIDER NUMBER