=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427104850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARRY SCOTT GARCIA D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 08/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 WELLNESS WAY SUITE 100
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-388-9510
-----------------------------------------------------
Fax | 772-388-1659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3955 INDIAN RIVER BLVD STE 100
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-2330
-----------------------------------------------------
Fax | 772-569-2630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | OS0004662
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------