Provider Demographics
NPI:1447903661
Name:BALDERA GARCES, ERICKSON A (MD)
Entity type:Individual
Prefix:DR
First Name:ERICKSON
Middle Name:A
Last Name:BALDERA GARCES
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 1:2003 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7821
Mailing Address - Country:US
Mailing Address - Phone:866-370-4022
Mailing Address - Fax:888-440-2194
Practice Address - Street 1:18954 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7730
Practice Address - Country:US
Practice Address - Phone:866-370-4022
Practice Address - Fax:888-440-2194
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN15132084P0800X, 208D00000X
PR023133208D00000X
PR16073I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty