Provider Demographics
NPI:1396939062
Name:GARCIA, JUAN F (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1718 N EDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254
Mailing Address - Country:US
Mailing Address - Phone:904-781-6203
Mailing Address - Fax:904-781-6207
Practice Address - Street 1:1718 EDGEWOOD AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1757
Practice Address - Country:US
Practice Address - Phone:904-781-6203
Practice Address - Fax:904-781-6207
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15478WMedicare PIN
FLD85120Medicare UPIN