Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ACN 246 | FL |
NPI | 1043644982 |
---|---|
Provider Name | Marie Josephine Garcon |
First Address | Alachua, FL 32615-9303 |
Second Address | Lake Butler, FL 32054-5721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 28/08/2013 |