Healthcare Provider Details

I. General information

NPI: 1407971922
Provider Name (Legal Business Name): GARCIA MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E NELSON AVE
DEFUNIAK SPRINGS FL
32433-7444
US

IV. Provider business mailing address

411 E NELSON AVE
DEFUNIAK SPRINGS FL
32433-7444
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-4791
  • Fax: 850-892-3868
Mailing address:
  • Phone: 850-892-4791
  • Fax: 850-892-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME59559
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME59559
License Number StateFL

VIII. Authorized Official

Name: MR. RUBEN RUIZ GARCIA JR.
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 850-892-4791