| Doctor Name: | DR. EDIBERTO DEJESUS GARCIA |
| NPI Number: | 1598836314 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101240450 |
| Business Practice Address: | 200 Clinic Dr Madisonville, KY - 424311661 |
| Business Phone Number: | 2708257351 |
| Business Fax Number: | 2708256630 |
| Mailing Address: | Po Box 950248, LOUISVILLE |
| State: | KY |
| Postal Code: | 402950248 |
| Phone Number: | 5024895730 |
| Fax Number: | 5024895733 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 01/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101240450 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |