Provider Demographics
NPI:1104856400
Name:GARCIA, JUAN A (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
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 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3258
Mailing Address - Country:US
Mailing Address - Phone:210-655-6400
Mailing Address - Fax:
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3258
Practice Address - Country:US
Practice Address - Phone:210-655-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154573939Medicaid
TX046741104Medicaid
TX046744103Medicaid
TX046744102Medicaid
TX8G9621Medicare PIN
TX8G9622Medicare PIN
TX8G9624Medicare PIN
TX8G9623Medicare PIN
TX046741104Medicaid
TXC4588G9621Medicare PIN