Healthcare Provider Details

I. General information

NPI: 1396724050
Provider Name (Legal Business Name): JESUS RENE GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 RUE DE ONETTA
NEW IBERIA LA
70563-2164
US

IV. Provider business mailing address

613 RUE DE ONETTA
NEW IBERIA LA
70563-2164
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-6776
  • Fax: 337-367-7330
Mailing address:
  • Phone: 337-367-6776
  • Fax: 337-367-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number09677R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number09677R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: