Healthcare Provider Details

I. General information

NPI: 1083100895
Provider Name (Legal Business Name): RAUL ANGEL GARCIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

IV. Provider business mailing address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-8484
  • Fax:
Mailing address:
  • Phone: 816-932-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS02635
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2500063290
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB10410100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: