Provider Demographics
NPI:1366794463
Name:GARCIA, JOSE GUADALUPE (MPAS, PA-C)
Entity type:Individual
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First Name:JOSE
Middle Name:GUADALUPE
Last Name:GARCIA
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Gender:M
Credentials:MPAS, PA-C
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Mailing Address - Street 1:4060 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2233
Mailing Address - Country:US
Mailing Address - Phone:432-582-2882
Mailing Address - Fax:432-582-2884
Practice Address - Street 1:4060 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2233
Practice Address - Country:US
Practice Address - Phone:432-582-2882
Practice Address - Fax:432-582-2884
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2023-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373243001Medicaid