=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083824262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE RAMON GARCIA GUERRA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 05/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 2808
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-5981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-586-1875
-----------------------------------------------------
Fax | 386-586-1871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 2808
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-5981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-586-1875
-----------------------------------------------------
Fax | 386-586-1871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 4301081390
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME101585
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------