Provider Demographics
NPI:1568457422
Name:GARCIA-CHUNG, DELORES R (MD)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:R
Last Name:GARCIA-CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3000
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:950 COUNTY ROAD 17A W
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2164
Practice Address - Country:US
Practice Address - Phone:863-452-3000
Practice Address - Fax:863-452-3029
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04093OtherBCBS OF FLORIDA
FL261691200Medicaid
FL04093OtherBCBS OF FLORIDA
FL261691200Medicaid