Healthcare Provider Details

I. General information

NPI: 1013413954
Provider Name (Legal Business Name): JOSEPH MICHAEL GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

IV. Provider business mailing address

1990 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-9300
  • Fax:
Mailing address:
  • Phone: 985-868-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number330958
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: