Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 18329 | WI |
NPI | 1003817925 |
---|---|
Provider Name | Larry Steven Garsha |
First Address | Orange Park, FL 32073-5728 |
Second Address | Orange Park, FL 32073-5728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 01/08/2014 |