Provider Demographics
NPI:1174557672
Name:GARCIA, GEORGE L (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
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 1:49TH MEDICAL GROUP/SGOPF
Mailing Address - Street 2:280 FIRST STREET, BLDG 23
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-7091
Mailing Address - Fax:575-572-2259
Practice Address - Street 1:49TH MEDICAL GROUP/SGOPF
Practice Address - Street 2:280 FIRST STREET, BLDG 23
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-7091
Practice Address - Fax:575-572-2259
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD11376207Q00000X, 207V00000X
NM82-193207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208549915Medicaid
D43130Medicare UPIN
MO7769489BMedicare PIN