Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | H6228 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | H6228 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME147875 | FL |
NPI | 1104804293 |
---|---|
Provider Name | Dr. Eddie Alonzo Garcia |
First Address | Sebring, FL 33872-2170 |
Second Address | Sebring, FL 33872-2170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 24/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165438601 | (05) | TX |
8G1481 | BCBS (01) | TX |
E16348 | (02) |