MEDICARE: JESSE REEVES-GARCIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	ME0051318	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200918	OTHER	FL	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	09858	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1134150477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE REEVES-GARCIA MD

Provider Business Mailing Address
First Line	:	3200 SW 60TH CT
Second Line	:	SUITE 204
City	:	MIAMI
State	:	FL
Zip	:	33155-4000
Country	:	US
Telephone Number	:	305-661-6110
Fax Number	:	305-662-5882

Provider Business Practice Location Address
First Line	:	8955 SW 87TH CT STE 206
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2223
Country	:	US
Telephone Number	:	786-888-2480
Fax Number	:	305-274-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/07/2021

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