Provider Demographics
NPI:1750388849
Name:GARTON, GRACIELA R (MD)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:R
Last Name:GARTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:15681 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-437-1977
Practice Address - Fax:239-437-1889
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00542972085R0001X
NC2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLF565OtherMEDICARE
FL103652200Medicaid
FL4620996OtherAETNA PROVIDER NUMBER
FL6599194-015OtherCIGNA PROVIDER NUMBER
FL0056OtherAVMED PIN NUMBER
FL15785OtherWELLCARE PROVIDER #
FL204586OtherAVMED PROVIDER NUMBER
FL207227OtherAMERIGROUP GROUP #
NC6599194020OtherCIGNA PROVIDER NUMBER
FL24-05241OtherUTD. HLTHCR. PROVIDER #
NC4620996OtherAETNA PROVIDER NUMBER
FL00787OtherUNIV. HLTHCR. PROVIDER #
FLME54297OtherMETCARE PROVIDER ID #
FLP-11201998OtherMULTIPLAN PROVIDER NUMBER
NC89134HAMedicaid
FL207227OtherAMERIGROUP GROUP #
NC89134HAMedicaid
FL24-05241OtherUTD. HLTHCR. PROVIDER #