Provider Demographics
NPI:1194719666
Name:GARZA, MARIO A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:GARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8415 DATAPOINT DR STE 700
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3327
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-614-0952
Practice Address - Street 1:855 PROTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4203
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-0952
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8381OtherBCBS
TX132179607Medicaid
TX132179607Medicaid
TX8B8634Medicare PIN