Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 51582 | MN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 54203-020 | WI |
NPI | 1073703153 |
---|---|
Provider Name | Dr. Alejandro Garcia |
First Address | Appleton, WI 54915-1800 |
Second Address | Appleton, WI 54915-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |
P00764025 | MEDICARE RAILROAD (01) | MN |