Provider Demographics
NPI:1104997543
Name:GARZA, ROBERT MALDONADO (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MALDONADO
Last Name:GARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S AUSTIN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7545
Mailing Address - Country:US
Mailing Address - Phone:512-863-7440
Mailing Address - Fax:512-869-8716
Practice Address - Street 1:3201 S AUSTIN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7545
Practice Address - Country:US
Practice Address - Phone:512-863-7440
Practice Address - Fax:512-869-8716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00402354OtherRAIL ROAD MEDICARE
TX8V1928OtherBCBS
TX1264095Medicaid
TXP00402354OtherRAIL ROAD MEDICARE
TX8J6637Medicare PIN