Healthcare Provider Details

I. General information

NPI: 1487648499
Provider Name (Legal Business Name): RAUL R GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S OAKWOOD RD
OSHKOSH WI
54904-7944
US

IV. Provider business mailing address

500 S OAKWOOD RD
OSHKOSH WI
54904-7944
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-2300
  • Fax:
Mailing address:
  • Phone: 920-223-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35749
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35749
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: