Provider Demographics
NPI:1962409383
Name:GARZA, RICARDO A (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:A
Last Name:GARZA
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 1:6800 IH 10 WEST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2039
Mailing Address - Country:US
Mailing Address - Phone:210-614-6391
Mailing Address - Fax:210-616-3327
Practice Address - Street 1:6800 IH 10 WEST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2039
Practice Address - Country:US
Practice Address - Phone:210-614-6391
Practice Address - Fax:210-616-3327
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8125207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F22EOtherGROUP BCBS #
TX82J692OtherMCR UPIN AHA
TXE41374OtherACC MCR UPIN
TXE41374OtherACC MCR UPIN
TX82J692OtherBCBS INDIVIDUAL #
TX082431001Medicaid
TX082431001Medicaid