Provider Demographics
NPI:1215965538
Name:GARCIA, CARLOS M (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:GARCIA
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 1:141 VINTON RD
Mailing Address - Street 2:STE E5
Mailing Address - City:VINTON
Mailing Address - State:TX
Mailing Address - Zip Code:79821-8810
Mailing Address - Country:US
Mailing Address - Phone:915-886-3088
Mailing Address - Fax:915-886-3022
Practice Address - Street 1:141 VINTON RD
Practice Address - Street 2:STE E5
Practice Address - City:VINTON
Practice Address - State:TX
Practice Address - Zip Code:79821-8810
Practice Address - Country:US
Practice Address - Phone:915-886-3088
Practice Address - Fax:915-886-3022
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2670207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V1452OtherBC/BS OF TEXAS
TXD49618Medicare UPIN