=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477566966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARDO E GARCIA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4054 BEAVER LN SUITE 1
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-9296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-613-6850
-----------------------------------------------------
Fax | 941-613-6851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28370 COCO PALM DR
-----------------------------------------------------
City | PUNTA GORDA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33982-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-637-5833
-----------------------------------------------------
Fax | 941-637-5833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME91360
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------