Provider Demographics
NPI:1043427099
Name:GARCIA, OMAR M (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 KINGSLEY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5174
Mailing Address - Country:US
Mailing Address - Phone:904-276-5400
Mailing Address - Fax:904-276-5430
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-276-5400
Practice Address - Fax:904-276-5430
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99927207L00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH188ZMedicare PIN