Provider Demographics
NPI:1588752380
Name:GARCIA, OCTAVIO JAVIER SR (MD)
Entity type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:JAVIER
Last Name:GARCIA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OCTAVIO
Other - Middle Name:JAVIER
Other - Last Name:GARCIA
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:822 KINNEY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-3006
Mailing Address - Country:US
Mailing Address - Phone:361-883-1405
Mailing Address - Fax:361-883-1406
Practice Address - Street 1:822 KINNEY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3006
Practice Address - Country:US
Practice Address - Phone:361-883-1405
Practice Address - Fax:361-883-1406
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE84982086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
C15900Medicare UPIN
TXKK61Medicare ID - Type Unspecified