Provider Demographics
NPI:1154339455
Name:ATKINSON-GARZA, ELOISE (MD)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:
Last Name:ATKINSON-GARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELOISE
Other - Middle Name:
Other - Last Name:BEIGHTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18540 SIGMA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4274
Mailing Address - Country:US
Mailing Address - Phone:210-490-4661
Mailing Address - Fax:210-490-4795
Practice Address - Street 1:18540 SIGMA RD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3280
Practice Address - Country:US
Practice Address - Phone:210-490-4661
Practice Address - Fax:210-490-4795
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1926207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81K563Medicare ID - Type Unspecified
TXE46782Medicare UPIN