MEDICARE: JEROME GARCIANO ENAD 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME112561	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14M8Q	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235104522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME GARCIANO ENAD MD

Provider Business Mailing Address
First Line	:	PO BOX 2699
Second Line	:	ATTN: SHMG/HPE
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2699
Country	:	US
Telephone Number	:	850-229-5792
Fax Number	:	850-229-5662

Provider Business Practice Location Address
First Line	:	3871 E HIGHWAY 98
Second Line	:	SUITE 202
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-5301
Country	:	US
Telephone Number	:	850-229-5792
Fax Number	:	850-229-5662

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/16/2015

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