Provider Demographics
NPI:1417991324
Name:GARCIA, LUIS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MANUEL
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 1:2390 CENTRAL BLVD
Mailing Address - Street 2:STE M
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8737
Mailing Address - Country:US
Mailing Address - Phone:956-574-9096
Mailing Address - Fax:956-541-8418
Practice Address - Street 1:1040 W JEFFERSON ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6338
Practice Address - Country:US
Practice Address - Phone:956-698-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4924207ZP0102X
WAMD00022449207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110726002Medicaid
E36545Medicare UPIN
TX00L01YMedicare ID - Type Unspecified