Healthcare Provider Details

I. General information

NPI: 1841491701
Provider Name (Legal Business Name): WAYNE J. GARCIA MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PASADENA AVE S
SOUTH PASADENA FL
33707-3717
US

IV. Provider business mailing address

PO BOX 67310
ST PETE BEACH FL
33736-7310
US

V. Phone/Fax

Practice location:
  • Phone: 727-431-9548
  • Fax:
Mailing address:
  • Phone: 727-431-9548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME0046918
License Number StateFL

VIII. Authorized Official

Name: DR. WAYNE J. GARCIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-431-9548