Provider Demographics
NPI:1235104522
Name:ENAD, JEROME GARCIANO (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:GARCIANO
Last Name:ENAD
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:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-229-5792
Mailing Address - Fax:850-229-5662
Practice Address - Street 1:3871 E HIGHWAY 98
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5301
Practice Address - Country:US
Practice Address - Phone:850-229-5792
Practice Address - Fax:850-229-5662
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112561207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14M8QOtherBCBS
FL0066090-00Medicaid
FL14M8QOtherBCBS