MEDICARE: DR. ERICKSON A BALDERA GARCES 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	390200000X	Student in an Organized Health Care Education/Training Program	16073I	PR
2	2084P0800X	Psychiatry Physician	ACN1513	FL
3	208D00000X	General Practice Physician	023133	PR
4	208D00000X	General Practice Physician	ACN1513	FL

General Provider Information

NPI Number	:	1447903661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICKSON A BALDERA GARCES MD

Provider Business Mailing Address
First Line	:	40083 HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7800
Country	:	US
Telephone Number	:	352-259-2159
Fax Number	:	407-944-3503

Provider Business Practice Location Address
First Line	:	40083 HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7800
Country	:	US
Telephone Number	:	352-259-2159
Fax Number	:	407-944-3503

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

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	03/23/2026

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