Provider Demographics
NPI:1205854783
Name:GARCIA, KEITH S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-0157
Mailing Address - Country:US
Mailing Address - Phone:512-829-4210
Mailing Address - Fax:512-394-0563
Practice Address - Street 1:13341 US 290
Practice Address - Street 2:BLDG 1-103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-829-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020100452084P0800X
TXN76962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219524001Medicaid
TXTXB119211Medicare PIN
H15943Medicare UPIN