Provider Demographics
NPI:1255548152
Name:GARCIA, JAIME (MD)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 W 49TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3436
Mailing Address - Country:US
Mailing Address - Phone:305-827-2489
Mailing Address - Fax:305-828-1533
Practice Address - Street 1:935 W 49TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3436
Practice Address - Country:US
Practice Address - Phone:305-827-2268
Practice Address - Fax:305-828-1533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067819207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377108300Medicaid
FL650799811OtherTAX ID NO.
FL377108300Medicaid