Basic Information
| Provider Information | |||||||||
| NPI: | 1255885471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 NW 9TH ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052312900 | ||||||||
| FaxNumber: | 4052724905 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 NW 9TH ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052312900 | ||||||||
| FaxNumber: | 4052724905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2016 | ||||||||
| LastUpdateDate: | 01/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2619 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 2619 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.