Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD068885-L | PA |
N | 208600000X | Surgeon | MD068885-L | PA |
N | 2086S0102X | Surgical Critical Care | D68115 | MD |
N | 2086S0127X | Trauma Surgeon | D68115 | MD |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01079211A | IN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD0688885L | PA |
NPI | 1033261227 |
---|---|
Provider Name | Jose Perez Garcia |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
577296 | (02) | |
F77296 | (02) | MD |