Provider Demographics
NPI:1902808314
Name:PEREZ-GARCIA, MARIA DEL CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:PEREZ-GARCIA
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 1:2001 COUNTY ROAD 210 W STE 101
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2063
Mailing Address - Country:US
Mailing Address - Phone:904-450-8402
Mailing Address - Fax:904-450-8152
Practice Address - Street 1:1302 RIVER ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-5042
Practice Address - Country:US
Practice Address - Phone:386-328-8371
Practice Address - Fax:386-325-1086
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009933800Medicaid
I13986Medicare UPIN