=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104961184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGOIRE GARCON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 12/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 S STATE ROAD 7
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33068-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-535-1919
-----------------------------------------------------
Fax | 954-973-3514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 S STATE ROAD 7
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33068-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-535-1919
-----------------------------------------------------
Fax | 954-973-3514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO2497
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------