MEDICARE: JM GARMENDIA MD PA

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	207R00000X	Internal Medicine Physician	ME0053646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497034912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JM GARMENDIA MD PA

Provider Business Mailing Address
First Line	:	2636 OAK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4506
Country	:	US
Telephone Number	:	904-384-5553
Fax Number	:	904-384-2173

Provider Business Practice Location Address
First Line	:	2636 OAK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4506
Country	:	US
Telephone Number	:	904-384-5553
Fax Number	:	904-384-2173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE MANUEL GARMENDIA
Credential	:	M.D,
Telephone Number	:	904-384-5553

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	11/17/2011

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