MEDICARE: LARRY STEVEN GARSHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	18329	WI
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	18329	WI
3	2084P0800X	Psychiatry Physician	18329	WI

General Provider Information

NPI Number	:	1003817925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY STEVEN GARSHA M.D.

Provider Business Mailing Address
First Line	:	2858 COUNTRY CLUB BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5728
Country	:	US
Telephone Number	:	904-579-4553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2858 COUNTRY CLUB BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5728
Country	:	US
Telephone Number	:	904-579-4553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/01/2014

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