Provider Demographics
NPI:1083686877
Name:DE LA GARZA-GRAHM, MARGARITA (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:DE LA GARZA-GRAHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2033
Mailing Address - Country:US
Mailing Address - Phone:903-593-5500
Mailing Address - Fax:903-593-5408
Practice Address - Street 1:1020 E LAKE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2033
Practice Address - Country:US
Practice Address - Phone:903-593-5500
Practice Address - Fax:903-593-5408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1225208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17029Medicare UPIN
00H64TMedicare ID - Type Unspecified