Provider Demographics
NPI:1821485509
Name:GARZA, JESUS E (PA)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:E
Last Name:GARZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 W ALTON GLOOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4474
Mailing Address - Country:US
Mailing Address - Phone:956-541-6725
Mailing Address - Fax:956-541-2070
Practice Address - Street 1:3475 W ALTON GLOOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4474
Practice Address - Country:US
Practice Address - Phone:956-541-6725
Practice Address - Fax:956-541-2070
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348975901Medicaid
TX411173YLPSOtherWELLMED PTAN