MEDICARE: GREGOIRE GARCON MD

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2497	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65394	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1104961184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGOIRE GARCON MD

Provider Business Mailing Address
First Line	:	612 S STATE ROAD 7
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33068-1734
Country	:	US
Telephone Number	:	954-535-1919
Fax Number	:	954-973-3514

Provider Business Practice Location Address
First Line	:	612 S STATE ROAD 7
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33068-1734
Country	:	US
Telephone Number	:	954-535-1919
Fax Number	:	954-973-3514

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	12/06/2012

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Directions to “ GREGOIRE GARCON MD” Practice Location

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