MEDICARE: DR. JESUS RENE 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	207Q00000X	Family Medicine Physician	09677R	LA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	09677R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396724050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS RENE GARCIA MD

Provider Business Mailing Address
First Line	:	613 RUE DE ONETTA
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2164
Country	:	US
Telephone Number	:	337-367-6776
Fax Number	:	337-367-7330

Provider Business Practice Location Address
First Line	:	613 RUE DE ONETTA
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2164
Country	:	US
Telephone Number	:	337-367-6776
Fax Number	:	337-367-7330

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/03/2010

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