Provider Demographics
NPI:1336595040
Name:CARLOS, EARL GERALD GARCIA (DO)
Entity type:Individual
Prefix:
First Name:EARL GERALD
Middle Name:GARCIA
Last Name:CARLOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAJO SERVICE RTE 41
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510
Mailing Address - Country:US
Mailing Address - Phone:928-725-9626
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO SERVICE RTE 41
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.152147207Q00000X
MI5101022805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine